Pre-Encounter Rep Position Available In Franklin, Vermont

Pre-Encounter Rep

Job Category:

Administrative Support

Requisition Number:

PREEN001142

Posting Details

Posted:

June 16, 2025
Full-Time
Hybrid
Locations
1 location
St. Albans, VT 05478, USA
Job Details
Description
Pre-Encounter Representative

JOB SUMMARY

• The Pre-Encounter Representative I performs ambulatory, outpatient, and inpatient scheduling, pre-registration, registration, payer eligibility, and complex financial clearance, specifically in a call center environment, or by floating to various medical group/hospital department locations. Obtains insurance pre-certification and prior authorization for services. Works to assist patients and families with meeting financial requirements. Estimates and collects point of service payments from patients. Provides exceptional patient focused customer service. Communicates effectively to clinical departments to maximize patient flow and customer service. May perform additional functions of a Patient Access Representative – Clinic as required.

PRE-REQUISITES

•

Education:

High school diploma or equivalent required. Associates degree preferred.

Experience:

Prior customer service experience preferred. Experience in medical office/hospital setting preferred, but not required.

Skills:

Basic computer and typing skills required. Must be detail oriented, organized, be able to handle multiple tasks and responsibilities and prioritize appropriately, have basic math skills to collect money and make change, and have strong communication skills to communicate with people in a professional and tactful manner.

RELATIONSHIPS

Reports To:

Patient Access Supervisor

Supervises:

Other Contacts:

Providers and their staff, patients and their families, hospital staff, general public.

SCOPE:

Machinery or Equipment Used:

Computer and basic office equipment, multi-line phone system

Physical Demands:

Sitting for long periods, standing and walking, manual dexterity and mobility, may need to push a patient in a wheelchair

Working Conditions:

Medical office environment

Required Protective Equipment:

PPE as patient condition or situation dictates

ESSENTIAL FUNCTIONS

• Registration Functions
Collects pertinent demographic and financial information according to HIPAA guidelines.
Registers and pre-registers ambulatory, outpatient, and inpatient visits for all locations.
Appropriately documents registration and pre-registration activities.
Ensure patient is directed to correct clinical area for service.
Maintains high attention to detail by reviewing all work for completeness and accuracy in compliance with organizational quality assurance policies.
Completes registrations to meet department accuracy and error resolution key performance indicator standards by maintaining >90% Final Accuracy and >75% Error Resolution. Captures required necessary patient information and signatures from parent/guardian for minor patients.
Ensures that patient/guardian signatures are obtained on consent forms, Notice of Privacy Practice, Package Price Agreements, ABN’s, and other documents as appropriate.
Always copies/scans both sides of insurance card and photo id.
Verifies insurance eligibility and ensures pre-cert and/or authorization has been obtained as required. Explains insurance benefits to patient so that financial obligations are understood.
For Medicare patients, completes the Medicare Secondary Payer Questionnaire (MSP) per CMS regulations, demonstrating the ability to determine primary/secondary insurance coverage based on the patient’s responses to the questions.
For Medicare patients, checks the medical necessity of expected services. Completes an Advance Beneficiary Notice (ABN) when CMS does not consider services medically necessary.
Collects all pre-determined self-pay sums at time of registration.
Demonstrates compliance with specified insurance requirements.
Coordinates with other departments to achieve quality patient encounters.
Assists patient/organization in meeting financial goals. Provides initial counseling to patients on NMC and other financial assistance programs, including local, state and federal programs. Provides appropriate paperwork and refers patients to Financial Counselors as needed.
• Scheduling Functions
Assists patients, physician offices, and hospital departments by determining needs, scheduling, rescheduling, or canceling appointments, or referring patient to appropriate personnel.
Codes and enters orders and appointment information into files and scheduling database.
Communicates physician requests for emergency interruptions of the schedule in progress.
Reviews entries to ensure accuracy and completeness.
Schedules patients to NMC departments based on pre-determined appointment arrangements, templates, and protocols to serve an adequate number of patients as established by departmental protocols.
When scheduling appointments, carefully screens patients for appropriate physician orders if applicable, and informs patient of information that must be presented at time of visit.
Handles any necessary arrangements needed to optimize the patient experience on the date of service including securing and scanning orders, determining special needs, facilitating insurance pre-cert/authorization with providers, performing pre-service collections, and ensuring necessary supplies are available.
Consistently Manages gaps in schedule to ensure maximum appointment utilization.
When preferred appointment date and time is not available to the patient, adds patient to the appointment waitlist.
Monitors canceled appointment and retrieves appointments from the waitlist as needed.
Responsible to follow up on any no show visits.
Schedules incoming referrals.
Handles a high volume of inbound and outbound phone calls.
•

Prior Authorization and Financial Clearance Functions:

Maintains a solid understanding of the Prior Authorization process for all major insurance payors.
Reports pertinent, concise information concerning insurance eligibility.
Utilizes department specific knowledge to ask appropriate follow up questions when information is unclear or vague.
Monitors all upcoming hospital-based services (Diagnostic Imaging, Surgical Services, etc.) to ensure all authorizations are established. Validates these prior authorizations with the payers as necessary. Obtains missing prior authorizations.
Provides complex estimates for procedures as needed.
Generate Good Faith Estimates for self-pay patients and inform them of their financial obligation.
Assist underinsured patients by facilitating financial counseling activities and providing resources available to obtain insurance.
Acts as a resource for complex insurance eligibility, and financial estimations. Liaise with patients and insurance payers to resolve complex eligibility issues. Explains complex insurance plans in a simple manner to ensure patient understanding.
• Patient Access Level I Job Duties
Cross functional in at least one of the following Patient Access units. May be required to cross train in additional areas dependent on needs.
Scheduling
Pre-Registration Financial Clearance OR
Prior Authorization
•

Other Job Specific Duties:

Coordinates issues/problems effectively with physician’s office, physician or other hospital department management as needed for problem resolution.
Utilizes department specific knowledge to ask appropriate follow up questions when information is unclear of vague.
Maintain a clean workspace and waiting area.
Manages self and resources effectively.
Acknowledges limits of experience and capability.
Identifies learning needs and seeks resources.
Utilizes equipment, systems and supplies appropriately.
Maintain clean, orderly environment of care.
Attends at least 50% of monthly staff meetings.
May perform additional functions of a Patient Access Representative – Clinic as required.
Other Duties as Assigned Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the notice from the Department of Labor.