Nuvance Health Careers

Description

Summary:

Responsible for all accountabilities of Level 1 and 2 Pre-Service Specialist. Provides training and guidance to staff. Responsible for supervisory activities in the absence of the department supervisor. Facilitates patient flow through the referral, scheduling, and financial clearance process. Responsible for obtaining demographic and financial information to ensure accurate patient identification and to secure reimbursement. Performs pre-registration functions and insurance eligibility verification. Provides estimates for services. Requests and secures payments.

Responsibilities:

1.Performs all responsibilities of the Level 1 & 2 Pre-Service Specialist. 2.Contributes to the design and flow of all processes and procedures within the Department. Is fully cross-trained to either schedule or financially clear all modalities that the team is responsible for. 3. May also be cross trained to all teams within the Contact Center, Financial Clearance, and Central Referral Departments. 4.Provides supervision, guidance and training to level 1 and level 2 Pre-Service Specialist and support staff. Responsible for supervisory activities in the absence of the department supervisor. Assists new employees to the department by shadowing, providing guidance, sharing knowledge, and training on department policies, workflows, and procedures. 5.May be assigned to schedule patients for hospital or medical group services by incoming phone calls, online requests, or outbound to patients. 6. May be assigned to work within the central referral management system to identify and schedule specialist and primary care referrals to NHMP practices as well as external providers when appropriate, with the goal of promoting in-system retention of patients and continuity of care. 7. Provides excellent customer service both to physician offices and patients. Contributes to reduction of abandoned call rate, length of calls, and average speed answered through use of best practices and workflow improvements as defined by management. Receives incoming faxed physician orders. Verifies orders for compliance and accuracy. 8.Performs insurance eligibility verification and executes payer requirements as needed. Obtains accurate insurance benefit information from payers, such as deductible, copay, and coinsurance amounts. Utilizes patient estimation tool to calculate estimate of patient liabilities. Requires an understanding of coding, procedural protocols and the charge description master. 9.Initiates requests for authorizations, pre-certifications, notices of admission, and referrals from insurance companies. Follows up with payers and providers to ensure that authorizations are in place. Takes appropriate steps to remediate situations in which financial clearance is not completed to ensure that Nuvance Health receives prompt payment for services rendered. 10.Contacts patients to perform pre-registration, including demographic verification, conveyance of insurance benefits, and estimates of liabilities. Collects on such liabilities prior to time of service utilizing provided scripting. Refers patients who express financial hardship to Financial Counseling for a financial assessment. 11.Safeguards patient confidentiality by adhering to all department, organization, state, and federal compliance guidelines. Fulfills all compliance responsibilities related to the position. 12.Performs other duties as assigned.

Other Information:

HS Diploma with minimum of 3-5 years job related experience. Associate degree with minimum 3 years job-related experience. Bachelor's Level Degree, with minimum 3 years� experience, preferred. PAL 2 - Preferred. Basic MS Word & MS Excel. Customer service and organizational skills. Criteria Desired: National Association of Healthcare Access Management (NAHAM) certification within one year of hire.

Working Conditions:

Manual: significant manual skills/motor coord & finger dexterity

Occupational: Little or no potential for occupational risk

Physical Effort: Sedentary/light effort. May exert up to 10 lbs. force

Physical Environment: Generally pleasant working conditions

Company: Nuvance Health Med Practice CT

Org Unit: 603

Department: Central Referral Office

Exempt: No

Salary Range: $21.49 - $41.73 Hourly