Wellforce Pre-Service Navigator in Lowell, Massachusetts
This position is an integral one in the Revenue Cycle to schedule and pre-register appointments in the Call Center.
Possible Work from Home option available after 9 months
•Coordinates with physicians, nursing homes, and outside agencies to obtain pertinent medical information. Accurately documents the patient’s stated complaint/admitting diagnosis and any procedures to be performed. Maintains knowledge of third party payers and/or managed care contractual requirements for pre-registration. This knowledge is demonstrated by the selection of the correct payer within the computer system and following any necessary procedures for medical necessity/ MSP, questionnaires, pre-certification, and referrals as required by the payer.
•Follows hospital policy regarding procedure for obtaining appropriate pre-certification and/or referrals insurance certification for all applicable insurance carriers.
•Consistently informs patients of current or past due financial obligations as required by the area specific benchmarks. A measure of this will vary by work area and would typically be one of the following: number of collections or percentage of collections.
•Generates the necessary appointment reminders and appointment instructions in a timely manner. Furthermore, add-on procedures are processed efficiently and accurately.
•Demonstrates knowledge of hospital financial and patient care systems and knowledge of medical terminology. Accurately spells medical diagnosis in the reason for visit field.
•Must maintain patient and hospital financial information confidentially in accordance with all hospital policy and any state or federal regulations such as the HIPAA Privacy & Security Standards.
•For auto and worker’s compensation registrations the appropriate information is collected from the responsible party including the auto or worker’s compensation carrier, agent and/or employer, date of injury, claim number. If the information is not collected, notes are properly documented as to why the information was not collected or available.
•Courteously answers telephone calls. Routes calls or takes accurate messages as appropriate.
•Follows hospital policy regarding procedures for eligibility verification of all accounts. Eligibility is properly documented within the patient’s record.
•Performs position specific job functions at an acceptable level of accuracy for quality assurance score for all areas of Registration. Meets the requirements of area specific benchmarks related to productivity and customer service such as wait times, call monitoring, number of registrations or calls processed, etc.
•Proficient in both Scheduling and Pre-Registration.
•Performs administrative duties as instructed and any other related duties as assigned.
•High school diploma or GED required
•Some college or Associates Degree preferred
•Insurance eligibility verification experience required