Pre-Services Coordinator (Prior Authorization)

Division:Eskenazi Health

Sub-Division: Hospital

Req ID: 26317

Schedule: Full Time

Shift: Days

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.

FLSA Status

Non-Exempt

Job Role Summary

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

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the first verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.

Nearest Major Market: Indianapolis