FTE: 1.0 FTE (40 hours per week)
Schedule: Monday-Friday from 8:00am-4:30pm
Holiday Rotation: N/A
Weekend Rotation: N/A
On Call Hours: N/A
The Pre-Encounter Specialist contacts all scheduled patients prior to their arrival to obtain current demographic information, verify insurance information, ensure pre-authorization requirements are met, and ensure patients understand their expected out of pocket costs for the services they intend to receive. Pre-encounter staff will attempt to collect any expected or outstanding patient balances prior to the appointment to reduce patient wait times and improve patient satisfaction. Additionally, Pre-Encounter staff will provide financial counseling and refer patients for evaluation of government assistance, as appropriate. This staff member works collaboratively with scheduling, financial counseling, and registration staff members to ensure patient experience is optimized and wait times are minimized on the day of service.
POSITION TECHNICAL RESPONSIBILITIES
Identifies and obtains missing patient demographic, insurance, order, or pre-authorization information by effectively communicating with patients, physicians, clinicians, front-end staff, and translators.
Utilizes online systems or phone communication to verify patient’s eligibility, benefits, and coverage.
Obtains pre-authorizations from third-party payers in accordance with payer requirements and/or follows up with referring clinics on missing or incomplete pre-authorizations.
Work with clinical staff to appeal any pre-authorization denials.
Provides patients with personalized estimates of their financial responsibility based on their insurance coverage.
Provides financial counseling when further explanation and education is needed regarding denied authorization, out-of-pocket liabilities, coverage options, payment plan, etc. Refer patients to vendor for assessment of governmental assistance, as needed.
Attempts to collect patient cost-sharing amounts (e.g., co-pays, deductibles) and outstanding bad debt before service.
Documents all payer communications and pre-service patient financial conversations, including payer decisions, collection attempts, and payment plan arrangements.
Other duties as assigned.
- Required: High school diploma or equivalent
- Preferred: Bachelor’s degree
- Required: 3 – 6 months previous customer service experience
- Preferred: 1 -3 years of previous healthcare experience, including medical terminology and patient collections
- Required: None
- Preferred: None
- Required: Patient Access Specialist Certification within one year of employment for employee hired after 1/1/2020. This will be provided by employer.
- Preferred: None
- Competitive health and dental insurance options
- Flexible paid time off to balance work and life
- Retirement plan with immediate vesting and employer match
- Free membership to our state-of-the-art fitness facility
- Generous tuition reimbursement
- Employer provided life and disability insurance
- Free parking at facility