Pre-Services Representative

24 hours ago


Myrtle Beach, South Carolina, United States Tidelands Health Full time
Job Title: Pre-Services Representative

At Tidelands Health, we are seeking a highly skilled Pre-Services Representative to join our team. This role is critical to securing reimbursement and minimizing organizational write-offs.

Key Responsibilities:
  • Verify patient and service information to ensure accurate and complete insurance verification, financial clearance, and prior authorization.
  • Prioritize and expedite urgent and emergent authorizations, working closely with insurance companies to accelerate responses.
  • Evaluate and assist with the evaluation of cases when insurance companies deny payment, determining next steps and building a case for appeal when necessary.
  • Interact with medical and professional staff to obtain clinical documentation for review, referring stakeholders to the clinical authorization team as needed.
  • Understand and apply payor regulations to participate in decision-making with the clinical team, advising and coordinating with providers regarding problematic admissions or episodes of service.
  • Perform various administrative support duties, including opening, sorting, and distributing mail and correspondence.
Requirements:
  • High School Diploma or equivalent required.
  • Two years of experience in Healthcare Revenue Cycle, including prior authorization, preferred.
  • Ability to interact successfully with the public, perform with a high degree of accuracy, and demonstrate strong interpersonal skills.

Tidelands Health is an equal opportunity employer and does not discriminate against employees or applicants for employment based on race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.



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