ChristianaCare, Union Hospital is looking for a detail-oriented Pre-Processing Representative to join our team!

Schedule:

• Full time: Monday - Friday - Days
• Attendance at special events as requested.
• Potential for occasional weekend or holiday assignments/projects

Job Summary: Provides insurance verification and authorizations for all scheduled and unscheduled outpatient services, through contact with insurance companies, physicians, employers, patients and patients’ families while increasing patient satisfaction.

Essential Job Functions:

• Demonstrates overall knowledge of authorization, benefits and claims processing for insurance payers and managed care plans.
• Obtains and documents benefits in the BAR system for cash collection and billing follow up.
• Communicates in a friendly and professional manner with physicians and insurance companies to ensure proper authorizations and paperwork are completed in a timely manner prior to patients services.
• Manage daily work list that is inclusive of both hospital and offsite diagnostic centers.
• Communicates with third party vendors and payers.
• Reviews all self pay patients for possible coverage including hospital system and also sends to Navigators for possible coverage and reviews patients ability to pay, etc.
• Properly notifies physician offices of scheduled studies for their patients while working with physician office staff to continue precertification requirements and clinical information and follow up with patient and office of any authorization issues and concerns.
• Communicates with offsite centers and hospital departments when there are discrepancies, authorization issues or problems to resolve in a timely manner to include cancel patients or reschedule patients as required.
• Provides documentation that is very clear and detailed for follow up purposes (ie; phone numbers, names of representatives, reference call numbers, authorization numbers, etc).
• Collaborates with billing staff to resolve denial trends, prepares denial documentation to billing staff when necessary.
• Verifies and updates all insurance information, demographics, etc. to ensure prompt and proper payment of the claim.

Education: High School Diploma or GED equivalent required. Some college course work preferred.

Licenses/ Certifications: None Required.

Experience: Previous healthcare or related experience preferred.

Skills

Required