Job Description Job Summary To complete accurate and timely verification of insurance for appropriate reimbursement. To coordinate information to the case management department and physician office to ensure pre-certification is obtained. To communicate with clients prior to service to establish payment expectations and initiate financial counseling. Ensures accurate liability is maintained on patient accounts.
Essential Functions - Successfully works with physician offices to obtain required authorization for procedures from different prayers to prevent reschedules and cancellations.
- Effectively and efficiently verifies all insurance benefits for all services to determine insurance coverage.
- Efficiently maintains department records, reports and files as required, entering pre-certification numbers timely.
- Consistently refers uninsured and underinsured patients for financial assistance.
- Obtain and verify Eligibility and Benefits information for patients.
- Processes pre-registration documents, and forwards to appropriate department
- Interact with physician offices and patients in a timely courteous manner
- Verifies insurance benefits, eligibility, and pre-determination requirements for all scheduled patients
- Coordinates with the physician's office when a required pre-determination has not been obtained
- Performs other duties as assigned.
- Complies with all policies and standards.
Qualifications - Other Completion of two years of college level classes required
- H.S. Diploma or GED required
- Less than 2 years of customer service required or
- Less than 2 years of experience in an insurance related industry required
- 2-4 years insurance verification experience in an acute care hospital or physician practice group preferred
Knowledge, Skills and Abilities - Prefer experience working with pre-certification. Insurance terminology is an asset.
- Ability to interact with patients, families, staff, management, physicians, representatives of insurance companies and other third-party payors, as well as the general public.