Pre-Services Representative II- Family Medicine Holmestown Road (Myrtle Beach, SC)
Company: Tidelands Health
Location: Myrtle Beach
Posted on: May 25, 2023
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Job Description:
POSITION SUMMARY: The purpose of this position is to obtain
prior authorizations or provide financial clearance for patients of
Tidelands Health. This role is key to securing reimbursement and
minimizing organizational write offs. The Pre-Services
Representative must consistently demonstrate skilled communication
and troubleshooting techniques as well as excellent customer
service skills. This position will have the ability to anticipate
and respond to a wide variety of issues/concerns, and the ability
to execute tasks efficiently and effectively. The position requires
the ability to independently plan, schedule and organize numerous
tasks as this position directly impacts hospital and physician
reimbursement.DUTIES:Confirms the need for an authorization and
takes the appropriate actions to ensure the authorization is
obtained.Verifies the basic patient/service information is
available - the minimum data set for scheduling a service. If not
present, initiates appropriate activity to obtain the required data
set, such as procedure codes.Prioritizes the urgency of the
authorization by anticipating the approximate time it may take
obtain the authorization from the insurance company, the complexity
of the procedure and the scheduled date of service; follows up with
insurance company to accelerate responses and expedite
urgent/emergent authorizations.Evaluates or assists with the
evaluation of cases when the insurance company has denied payment
to determine next steps; this may include building a case for
appeal.Interacts with medical and professional staff to obtain
appropriate clinical documentation for review; this may include
referring stakeholders to a member of the clinical authorization
team. Takes the appropriate actions when it appears that the
authorization will be not be provided on a timely basis; to include
escalation to the clinical authorization team.Understands the
critical delineations of patient status (outpatient, inpatient and
observation) based on payor regulations and participates in the
appropriate decision making with the clinical team members such as
care management or with billing.Advises and coordinates with
providers regarding problematic (i.e. high risk) admissions or any
episode of service requiring additional attention.Performs various
administrative support duites for department/work location. Opens,
sorts and distributes all types of mail and correspondence as is
necessary and assigned.EDUCATION REQUIRED:High School Diploma or
equivalent, required.EXPERIENCE REQUIRED:At least one (1) year of
experience in Healthcare Revenue Cycle that includes prior
authorization.ADDITIONAL PREFERRED EXPERIENCE:Knowledge of CPT and
ICD coding preferred.Knowledge of Medicare and third-party payer
regulations and guidelines highly
desired.KNOWLEDGE/SKILLS/ABILITIES (KSAs):Ability to interact
successfully with the public. Ability to perform effectively
despite sudden deadlines and changing priorities; maintaining
personal composure in high stress situations.Ability to demonstrate
a high level of interpersonal skills required to interact with
patients, patients' families/visitors and clinical staff.Ability to
perform with a high degree of accuracy and with meticulous
attention to detail. Demonstrate a strong ability to use initiative
and judgment and to identify, analyze and solve problems.PHYSICAL
REQUIREMENTS: LIGHT PHYSCIAL AGILITY TEST RATING (PAT)While
performing the duties of this job, the employee is frequently
(activity or condition exists from 1/3 to 2/3 of the time) required
to stand, sit, and walk; frequently to use hands, fingers; and
frequently to talk or hear. The employee must exert up to 15 pounds
of force occasionally (activity or condition exists up to 1/3 of
the time), and/or up to 5 pounds of force frequently, and/or a
negligible amount of force constantly to move objects. The physical
demands described here are representative of those that must be met
by an employee to successfully perform the essential functions of
this job and will be tested by post offer PAT.
Keywords: Tidelands Health, Wilmington , Pre-Services Representative II- Family Medicine Holmestown Road (Myrtle Beach, SC), Healthcare , Myrtle Beach, North Carolina
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