Patient Access Representative - Pre-Service

The Patient Access Representative – Pre-Service is responsible for completing pre-service financial clearance and registration activities to ensure accurate billing and reimbursement. This role obtains and verifies insurance benefits, authorizations, diagnoses, and procedure codes; provides financial counseling to patients; collects payments; and establishes payment arrangements before service. The Representative plays a critical role in reducing denials, improving upfront collections, and supporting a positive patient experience while maintaining compliance with hospital policies and HIPAA regulations.

ESSENTIAL JOB FUNCTIONS (including, but not limited to)

• Receive and review proposed services via phone, fax, email, or electronic worklists.
• Obtain and verify required pre-service documentation, including diagnoses, procedure codes, insurance eligibility, authorizations, and pre-certifications.
• Verify insurance benefits using Passport, payer portals, or other available resources to determine coverage and patient responsibility.
• Complete pre-registration by accurately entering demographic, insurance, financial, and medical information and creating patient accounts in the system.
• Counsel patients regarding insurance coverage, estimates, deductibles, co-insurance, and out-of-pocket responsibility.
• Collect pre-service payments and past-due balances and establish payment plans when appropriate.
• Communicate with clinic staff and physician offices to obtain authorization and pre-certification information and resolve discrepancies.
• Document all verification, authorization, and patient communications clearly and accurately in the patient account.
• Notify the Revenue Cycle Coordinator or Director of unusual cases, coverage issues, or extenuating circumstances requiring escalation.
• Maintain a high degree of accuracy and timeliness in all pre-service activities.
• Interact professionally and courteously with patients, families, providers, and internal departments.
• Provide backup support for other Patient Access or Revenue Cycle functions as needed.
• Maintain patient confidentiality and comply with all federal and state privacy regulations, including HIPAA.
• Support SHOLA’s culture of exceptional patient satisfaction and accountability.
• Performs special projects and other duties as assigned.