Patient Access Representative - Pre-Service

Description

The Patient Access Representative – Pre-Service is responsible for completing pre-service financial clearance and registration activities to ensure accurate billing and reimbursement. This role obtains and verifies insurance benefits, authorizations, diagnoses, and procedure codes; provides financial counseling to patients; collects payments; and establishes payment arrangements before service. The Representative plays a critical role in reducing denials, improving upfront collections, and supporting a positive patient experience while maintaining compliance with hospital policies and HIPAA regulations.

ESSENTIAL JOB FUNCTIONS (including, but not limited to)

• Receive and review proposed services via phone, fax, email, or electronic worklists.
• Obtain and verify required pre-service documentation, including diagnoses, procedure codes, insurance eligibility, authorizations, and pre-certifications.
• Verify insurance benefits using Passport, payer portals, or other available resources to determine coverage and patient responsibility.
• Complete pre-registration by accurately entering demographic, insurance, financial, and medical information and creating patient accounts in the system.
• Counsel patients regarding insurance coverage, estimates, deductibles, co-insurance, and out-of-pocket responsibility.
• Collect pre-service payments and past-due balances and establish payment plans when appropriate.
• Communicate with clinic staff and physician offices to obtain authorization and pre-certification information and resolve discrepancies.
• Document all verification, authorization, and patient communications clearly and accurately in the patient account.
• Notify the Revenue Cycle Coordinator or Director of unusual cases, coverage issues, or extenuating circumstances requiring escalation.
• Maintain a high degree of accuracy and timeliness in all pre-service activities.
• Interact professionally and courteously with patients, families, providers, and internal departments.
• Provide backup support for other Patient Access or Revenue Cycle functions as needed.
• Maintain patient confidentiality and comply with all federal and state privacy regulations, including HIPAA.
• Support SHOLA’s culture of exceptional patient satisfaction and accountability.
• Performs special projects and other duties as assigned.

Requirements

Education

• High school diploma or equivalent required. 

Experience

• Minimum of two (2) years of experience in healthcare scheduling or pre-registration preferred. 
• Experience with registration, insurance verification, financial counseling, and customer service is strongly preferred.

Unique Skills

• Strong customer service and communication skills in a healthcare setting.
• Ability to read, interpret, and apply CPT codes, diagnoses, and procedures.
• High attention to detail and accuracy.
• Ability to discuss financial responsibility with patients in a clear, compassionate manner.

Reports To: Patient Access Assistant Director

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, marital status, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law. Our company values diversity and inclusion, and we encourage all qualified applicants to apply for job openings.