Pre-Service Representative

  • South Georgia Medical Center
  • Valdosta, GA, USA
  • Apr 27, 2021
Customer Service

Job Description

POSITION SUMMARYResponsible for all aspects of scheduling of Inpatient and Outpatient proceduresKnowledgeable of recording patients into lobbying systemResponsible for the complete registration of a patientKnowledgeable of patient transfers and bed placements for all departmentsWill be held accountable for meeting the standard productivity rate of 94% to 105%.Must understand and comply with HIPPAKnowledgeable of Medicare and the questionnaire that must be completed on each Medicare patientResponsible for verifying insurance benefits and accurate entry of patient demographics and financial data.Will be responsible for fulfilling all PayNav functionalities including medical necessity on all Medicare patients, cost estimates for each patient and insurance verification on all patients.Strive to reach 100% of your personalized collection goal.Will be accountable for accuracy of information entered and documentation provided.Will be held accountable for meeting the standard accuracy rate of 98% or higher in AHIQA.Will coordinate referral of account to appropriate personnel, including Customer ServiceResponsible for maintaining, responding, and addressing all SGMC emails, phone calls, and voice messages.KNOWLEDGE, SKILLS & ABILITIESTechnical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, Series, Trace, PayNav, and Microsoft Office applications.Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia and Florida); Peach Care; Tricare (Standard, Extra and Prime);VA; Disability Adjudication Services; Vocational Rehabilitation; Childrens Medical Services; Cancer State Aid; Crime Victims Compensation Program; Knights Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Workers Compensation; Georgia Indigent Care Trust Fund; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.Strong verbal communication skills. Excellent customer service skills. Interacts with: patients; other departments; physician offices; other acute medical care providers; insurance companies; pre-certification companies; employers; intermediaries; utilization review companies; and state regulatory agencies (GMCF, Medicaid).Knowledge of, or coursework in, medical terminology.Familiarity with CPT Codes, HCPCS, and ICD-10, and PCI compliance.Related regulatory and legal requirements: Medicare Secondary Payer Questionnaire; Advance Directives (living wills, healthcare surrogate); medical necessity checking requirements; ABNs; letters of non-coverage; coordination of benefits.Reimbursement methodologies: percent-of charges; discounted fee-for-service; fee schedule; cost-based; capitation.Must have a thorough understanding and knowledge of patient type; financial class; insurance master; employer codes; clinic codes; physician coding; admission source codes; relationship codes; accommodation codes; special handling codes; medical service codes.College degree or coursework preferred. CPAR preferred.Must be able to organize workload in an efficient manner and type 40 wpm accurately.Previous data entry, programming, office coordinator experience highly preferred. Associated topics: assist, client, help, help desk, information technology analyst, patient, service, technician i, technician ii, technology



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