Pre-Arrival Unit Representative

Job Summary:

The Pre-Arrival Unit Representative plays a crucial role in ensuring seamless patient care by obtaining necessary authorizations and verifying eligibility and coverage. They communicate with internal and external stakeholder, maintain confidentiality, and contribute to process improvement.

Knowledge, Skills & Abilities:

Ensures seamless patient care by obtaining necessary authorizations and verifying eligibility and coverage. Ability to maintain confidentiality. Good verbal and written communication skills. Maintains professional standards. Effective organizational skills. Basic computer skills, including but not limited to proficiency in Microsoft Word and Excel, and basic data entry.  

Responsibilities:

Verify patient insurance eligibility and coverage.

Maintains strict confidentiality and adheres to all HIPAA guidelines and regulations.

Leverage available information (e.g., CPT codes, diagnosis codes) to obtain authorizations.

Obtain approval for services scheduled by external providers.

Pre-certify services requiring authorization in a timely and efficient manner.

Timely pre-certify outpatient procedures when applicable.

Complete Notification of Admission (NOA) promptly to notify relevant payers about patient admissions.

Communicate with patients, insurers, and relevant parties regarding insurance verification and authorization.

Communicate updates and address questions on work progress to team members, leadership, and external departments.

Strong written and verbal communication skills.

Environmental and Physical Demands:

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional working hours beyond regularly scheduled hours, occasional travelling to offsite locations, no activities subject to significant volume changes of a seasonal/clinical nature, occasional work produced is subject to precise measures of quantity and quality, occasional bending, occasional lifting/carrying up to 10 pounds, occasional lifting/carrying up to 25 pounds, occasional lifting/carrying up to 50 pounds, occasional lifting/carrying up to 75 pounds, occasional lifting/carrying up to100 pounds, no lifting/carrying 100 pounds or more, no climbing, no crawling, occasional crouching/stooping, occasional driving, occasional kneeling ,occasional pushing/pulling, frequent reaching, frequent sitting, frequent standing, occasional twisting, and frequent walking. (Occasional-up to 20%, frequent-from 21% to 50%, constant-51% or more)

Education & Experience:

High school diploma or equivalent required. One (1) year of experience in healthcare insurance verification is required. Associate degree or equivalent combination of related education and experience preferred. Knowledge of medical terminology, diagnosis, and CPT coding preferred.

Certifications, Licenses or Registration Required: N/A