Job Description
The Pre-Service Specialist reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines, and all other regulatory and accreditation standards.
The Pre-Service Specialist will schedule and pre-register patients for their upcoming service at Northwestern Medicine. This role includes scheduling the patient, updating the insurance information, performing medical necessity checks as appropriate, verifying the authorization was initiated by the physician’s office, check-in and check-out, and contacting the patient to notify them of any possible patient financial responsibilities.
Responsibilities:
- Politely and promptly answers and appropriately triages department telephone calls in an efficient, professional manner.
- Correctly identifies and collects patient demographic information in accordance with hospital standards.
- Schedules appointment in centralized scheduling system, in accordance with AIDET service standards using scripted language for greeting the caller, reviewing the scheduling activity and summarizing the transaction at the end of the call.
- Consistently practices Patients First philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere.
- Is proactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating relevant information and documenting order retrieval in notes for check-in person.
- Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations. Collects authorization numbers in appropriate systems as applicable
- Proactively obtain Email addresses and help enroll patients in Patient Portal
- Interacts with various hospital departments and physician’s offices to effectively schedule and direct patients through the NMHC systems in a patient/customer friendly manner.
- Utilizes multiple online order retrieval systems to verify or print the patient’s order
- Reach out to patients to schedule an appointment as defined
- When necessary, requests interpreter services for patient’s visit with Patient Representative Department. Utilizes the language line of the hospital to schedule patients who require interpretation service.
- Understands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration system
- Understands departmental and individual quality metrics, including– abandonment rates, average answer delay, RONA, AIDET scorecard, quality reviews, and not ready %.
- Performs medical necessity checks as necessary for scheduled services, communicates options to patient if appointment fails.
- Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions
- Completes Check-in process including confirming identity, offering MyChart enrollment, obtaining signatures, colleting co-pay/deposit/outstanding balances, validating parking, distributing office specific forms to fill out.
- Completes Check-out process including scheduling/coordinating requested follow-up appointments, printing AVS for non-MyChart patients and answering patient’s questions.
- Responds to questions and concerns. Forwards, directs and notifies Team Lead or Operations Coordinator of extraordinary issues as necessary.
- Evaluates procedures and suggests improvements to enhance customer service and operational efficiency.
- Verifies insurance eligibility and benefit levels through the use of online clearinghouse tools (NDAS, ASF, etc.) or over the phone as necessary.
- Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, worklists, and direct phone calls as necessary.
- Ensures that outpatient procedures have a valid ICD-9 code, and that for Medicare patients, medical necessity has been met. Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients.
- Informs patients of any issues with securing the financial account for their encounter.
- Completes out-of-pocket estimations as requested by patients.
- Provides professional and constructive environment for communication across units/departments and resolves operational issues. May attend intra/interdepartmental meetings which involve walking within NM Campus.
- Provides training and education as needed.
- Completes other duties assigned by manager. Cross-training between various departments may take place to ensure coverage.
- Communicates customer satisfaction issues to appropriate individuals.
- Participates in departmental quality improvement activities.
- Provides ideas and suggestions for process improvements within the department.
- Monitors registration and scheduling, including insurance verification to ensure processing within prescribed quality standards.
- Adjusts processes as needed to meet standards.
- Participates in Quality Assurance reviews to ensure integrity of patient data information.
Qualifications
Required:
- High School diploma.
- 1-2 years customer service experience.
- Proficient in typing.
Preferred:
- Bachelor’s degree.
- Healthcare Finance and/or Healthcare Insurance Knowledge.
- Experience in a healthcare setting, especially patient scheduling and/or registration.
- Coding Certification.
- Certified Healthcare Associate Designation (NAHAM).
Additional Information
Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background Check
Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.
Artificial Intelligence Disclosure
Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Sign-on Bonus Eligibility: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
