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Pre-Services Coordinator (Prior Auth)

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

The Pre-Services Coordinator works directly with patients, referring physician offices, and payers, to ensure full payer clearance prior to receiving care, through pre-registration, financial clearance, authorization, referral validation, and pre-serviceability estimations and collections. The Pre-Services Coordinator establishes the first impression of Eskenazi Health for patients, families, and other external/internal customers, serving as a subject matter expert as it relates to payer requirements, authorizations, appeals and patient navigation.

Essential Functions and Responsibilities:

• Conducts pre-registration functions, validates patient demographic data, identifies and verifies medical benefits, accurate plan codes and Coordination of Benefits orders
• Corrects and updates all necessary data to assure timely, accurate bill submission
• Maintains accountability for accuracy of data collected and entered into systems and demonstrates the ability to maintain the passing grade on monthly audits
• Verifies insurance information through payer contacts via telephone, online resources, or electronic verification systems and identifies payer authorization/referral requirements
• Provides appropriate documentation and follow up to patients, physician offices, case management departments, and payers regarding authorization/referral deficiencies
• Contacts insurance carriers or other sources to obtain prior authorizations; obtains pre-certification and/or authorization prior to services
• Identifies all patient financial responsibilities, calculates estimates, collects liabilities, posts payment transactions, and completes waivers as appropriate in the Epic system
• Identifies self-pay and complex liability calculations and escalates account to Financial Counselors as appropriate
• Delivers positive patient experience using AIDET
• Counsels patients regarding insurance benefits by explaining financial responsibilities for services received, payment options, and collections procedures to patients and parties responsible for payment
• Performs any written and verbal communication necessary to exchange information with designated contacts and promote working relationships with patients, Eskenazi Health leadership and staff, physician offices, and external/internal customers
• Initiates process for collecting prepays due and performs follow-up to insure maximum collection is achieved
• Updates and correctly documents in Epic
• Attains productivity standards, recommending new approaches for enhancing performance and productivity when appropriate
• Attains quality standards, recommending new approaches for enhancing quality when appropriate

Job Requirements:

Accredited Bachelor's degree preferred; OR four (4) years experience in a pre-services setting. High School Diploma or GED required.

• Certification in Healthcare Business Insights within 60 days of hire

Knowledge, Skills & Abilities:

• Understanding of Medicare regulations, Medicaid MRO, Medicaid Clinic Services, and Commercial insurance related to any necessary prior authorization process/requirements
• Advanced computer skills to facilitate the utilization of web based applications