MAJOR FUNCTION:

The Pre-Service/Pre-Cert Representative is responsible for ensuring all outpatient insurance requirements are completed in advance of patient’s scheduled appointment date. Representative must validate all insurances in HDX or via insurance portals, as needed. Representative is also responsible for ensuring authorizations are obtained via Recondo tool and/or to obtain hospital authorizations on behalf of physician practices, when applicable, prior to the patient’s scheduled procedure/testing date.



QUALIFICATIONS:

Education & Experience:

High School Diploma or GED equivalent required. Some college and/or CHAA certified preferred. Minimum of one-year experience working in a hospital registration area or physician’s office verifying medical insurance coverage via online portals- Navinet, Medicaid, Medicare- required.

Certification/Licensure: 

N/A

Knowledge & Skills:

Working knowledge of insurance plans, products, benefits, and authorization process and requirements preferred. Familiarity with 3rd party vendor process used for authorization submission via Evicore, AIM, GEMS preferred. Ability to organize accounts, work independently, and take direction as needed in addition to being detail oriented is a must. Must be able to work in a fast-paced environment with a diverse population while maintaining a professional attitude and providing great customer service. Computer proficiency required. Typing skills minimum 30-40 WPM required.

Physical Requirements: 
N: Never       O: Occasionally (<20%)       F: Frequently (20%-80%)       C: Constantly (>80%)

Lifting <20lbs

C

Standing

F

Sitting

C

Lifting 20-50lbs

O

Climbing

O

Kneeling

O

Lifting>50lbs

N

Crouching

O

Reaching

F

Carrying

F

Hearing

C

Walking

F

Pushing

F

Talking

C

Vision

C

 

Environmental Conditions:

Noise

F

Varied Temperatures

O

Cleaning Agents

F

Noxious odors

N

Patient Exposure

N

Operative Equipment

N