Pre Service Center Verification Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee financial clearance processes by managing pre-registration, validating demographics and insurance, verifying insurance, authorizing referrals, precertifying, and collecting cash prior to service.

• Track and manage registration, referral, and prior authorization work queues, ensuring compliance with management guidelines.

• Navigate BMC and payer policies to secure authorizations, precertifications, and referrals.

• Assist BMC staff in addressing and resolving financial clearance challenges.

• Secure insurance verification, authorizations, and referrals through online databases, electronic communication, faxes, and phone correspondence.

• Record referral and prior authorization details in Epic and other relevant practice management systems.

• Collaborate with practices, physicians, insurance carriers, patients, case management, Patient Financial Counseling, and various departments.

• Collect, verify, and update patient demographic, insurance, eligibility, primary care physician, subscriber, employer, and appointment data.

• Establish new patient registration records and ensure all required registration information is complete.

• Process copayments, coinsurance, deductibles, and any outstanding patient balances.

• Refer patients who are self-pay or have unresolved insurance issues to Patient Financial Counseling.

• Escalate accounts that have been denied or remain financially unclear in accordance with department policies.

• Conduct interviews with patients, families, and physicians by phone prior to appointments when feasible.

• Address and resolve issues related to registration, insurance verification, referral, and authorization.

• Uphold confidentiality and adhere to healthcare collection laws, HIPAA regulations, and organizational policies.

• Meet productivity and quality benchmarks, and engage in managed-care quality audits.

• Manage telephone inquiries and direct issues to the appropriate parties.

• Reach out to the BMC IT Help Desk or relevant vendors regarding any system or equipment malfunctions.

• Participate in mandatory training sessions and contribute to process-improvement initiatives.

• Perform additional related responsibilities as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• 1-3 years of experience in hospital registration and/or insurance is preferred.

• At least one year of experience should be in a customer service capacity.

• General familiarity with healthcare terminology and CPT-ICD10 codes.

• Comprehensive understanding of insurance processes is preferred.

• Proven customer service skills with the ability to apply judgment, independent thinking, and creativity in resolving issues.

• Outstanding interpersonal skills.

• Strong written communication abilities.

• Excellent verbal communication skills.

• Capability to function effectively in a complex environment with diverse perspectives.

• Comfortable navigating ambiguity, demonstrating good decision-making skills, and possessing a keen attention to detail.

• Knowledge of and experience using Epic is preferred.

• Technical proficiency in Epic work queues and ancillary systems, including ADT/Prelude/Grand Centrale.

• Ability to maintain the highest level of confidentiality regarding personal and health-sensitive information.

• Capacity to manage challenging situations and prioritize multiple tasks effectively.

• Basic computer skills, including data access, entry, and interpretation.

• Proficiency in Microsoft Suite applications, particularly Excel, Word, Outlook, and Zoom.

• Comprehensive knowledge of various sections within the work unit to provide support and backup coverage.

• In-depth understanding of Revenue Cycle processes.

• Must comply with HIPAA, hospital safety and infection control protocols, organizational policies, and BMC RESPECT behavioral standards.

🏝️ Benefits

• Medical, dental, vision, and pharmacy benefits.

• Opportunities for contract increases.

• Flexible Spending Accounts.

• 403(b) savings matches.

• Option for earned time cash out.

• Paid time off.

• Opportunities for career advancement.

• Resources available to support employee and family wellbeing.

• Educational offerings sponsored by BMC or other development opportunities.

• Remote work arrangements available.

• Employer does not require employees to purchase equipment for or before employment.