Pre-Services Representative

Overview

This role, operated by a partner organization, seeks a Pre-Services Representative based in the United States. The position focuses on assisting patients with critical administrative healthcare procedures prior to scheduled medical services, ensuring efficient operations, insurance verifications, and financial clarity for patients.

Key Responsibilities

• Verify patient insurance eligibility, benefits, and coverage before procedures.
• Perform insurance pre-authorization and pre-certification, accurately documenting the data within billing and electronic health record systems.
• Evaluate cases requiring additional approvals and collaborate with administrative teams on unapproved or low-revenue procedures.
• Communicate with patients and their families to clarify insurance coverage, financial obligations, payment expectations, and options.
• Update and confirm patient demographic and insurance data in internal systems.
• Register patients and ensure detailed documentation during the entire pre-service phase.
• Collect and review required patient payments including co-pays and deductibles.
• Engage with healthcare teams to resolve insurance, scheduling, and billing challenges.
• Adhere to healthcare privacy regulations and organizational policies.
• Support continuous process improvements and foster cooperative team dynamics.

Candidate Requirements

• High school diploma or GED mandatory; college degree preferable.
• At least two years of medical front-office experience involving insurance and scheduling functions.
• Familiarity with payer portals, insurance authorizations, payment policies, and reimbursement processes.
• Understanding of ICD-10 and CPT coding systems.
• Excellent communication and customer service aptitude to engage effectively with patients and families.
• Ability to work autonomously and collaboratively within team settings.
• Strong organizational skills with meticulous attention to detail and documentation accuracy.
• Adaptability to shifting priorities and an ability to function under uncertainty.
• Effective problem-solving skills to manage complex situations.
• Capability to handle sensitive conversations professionally and sustain positive relationships.
• Commitment to results with a patient-centered mindset.

Employee Benefits

• Health, dental, and vision insurance coverage.
• Health Savings Account featuring employer contributions.
• Life insurance benefits.
• Paid time off (PTO) availability.
• 401(k) retirement plan with company matching.
• Opportunity for remote work.
• A supportive workplace focused on meaningful healthcare service.
• Additional employee benefits and programs.

Additional Information

Applications are managed through an AI-enabled matching process that ensures objective and prompt evaluation against role requirements. Final hiring decisions and associated procedures are overseen by the partner company. Data protection and privacy compliance are embedded within the application process, including regulated processing of personal data and responsible use of AI tools assisting recruitment.