Pre Service Specialist 1

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.

Summary:
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:

• May be assigned to schedule patients for hospital or medical group services by incoming phone calls, online requests, or outbound to patients.
• 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.
• 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.
• 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.
• 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.
• 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.
• Safeguards patient confidentiality by adhering to all department, organization, state, and federal compliance guidelines. Fulfills all compliance responsibilities related to the position.
• Performs other duties as assigned.

Other information:
HS Diploma Required Minimum of 2-year job-related experience National Association of Healthcare Access Management (NAHAM) certification within one year of hire Basic MS Word & MS Excel. Customer service and organizational skills. Associates Degree Preferred with 6 months job-related experience – Preferred.

Location: Summit-100 Reserve Rd

Work Type: Full-Time

Work Shift: 8:30 to 5:00

Department: Corporate Financial Clearance

Grade: S3

Salary Range:

$15 – $21 Hourly

Working conditions:
Essential:
* Significant manual skills / motor coord & finger dexterity
* Some occupational risk
* Sedentary/light effort. May exert up to 10 lbs. force
* Generally pleasant working conditions.

EOE, including disability/vets.

We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.