Job Details

Job description

General Summary of Duties: Responsible for obtaining insurance verifications and approvals for office visits at a busy multispecialty healthcare organization.

Essential Functions:

• Gather relevant data for eligibility and benefit verification including all medical codes and billable CPT codes per orders
• Verify eligibility and medical benefits with third party payers for scheduled patient services and re-verification of the benefits for all the current patients
• Obtain prior authorizations, pre-determinations, or any prerequisites prior to services being rendered. Complete daily authorization report in the EMR
• Ensure the patient meets all criteria as outline by the third party payer’s reimbursement policies and or clinical policies
• Generate a patient financial treatment estimate and counsel each patient prior to the day of their scheduled office visit
• Identify patients in need of financial assistance and submit to the financial assistance department for evaluation
• Document all patient financial counseling activities, benefit details, eligibility and interactions in the patient’s electronic chart
• Communicate to scheduling personnel and ordering physicians and staff any delays in the financial counseling process including patients that are not cleared for their office visit in a timely manner
• Counsel, educate, and assist patients with inquiries regarding to their financial responsibility, assistance availability, insurance, and benefits

• Perform other duties assigned by management

Requirements:

• 6+ months experience in Benefits Verification experience or Prior Authorization experience-required
• High School Diploma or equivalent-required
• Billing and coding knowledge- preferred
• Minimum of 1 year experience as an insurance specialist in the healthcare environment performing clerical duties, billing duties in a hospital or physician practice setting- required
• Ability to project a professional image

Knowledge/Skills:

• Working knowledge of medical billing, CPT codes, and ICD10s
• Knowledge of medical terminology
• Proficiency with electronic medical records (EMR) and practice management software
• Strong knowledge of payer guidelines and reimbursement policies
• Effective interpersonal and communication skills
• Ability to work independently and collaboratively within a team environment
• Strong time management, organization, multi-task and analytical skills