Job Description

Position Summary

Work as part of a Team which is responsible for Insurance verification for the physician, hospital, or surgery appointments.

Essential Functions

• Verify insurance plan and network to make sure that the physician office, hospital, or ambulatory surgery center is participating.

• Contacts appropriate payers to verify insurance coverage and benefits.

• Knowledge in the use of understanding electronic verification tools and web based resources.

• Knowledge and familiar with a commercial and state funded insurance plans.

• Must be able to identify an HMO, POS, Open access and/or PPO type plan.

• Verify effective date, group number and claim address.

• Verify copays, deductible amounts, out of pocket amounts and co-insurance.

• Efficiently and accurately input the insurance information on the account for correct billing and proper referral processing.

• Reviews insurance coverage for same day appointments.

Reviews and works reports for future appointments.

• Rotate with other staff to work reports and immediate attention forms.

• Link patient /guarantor party to the insurance on accounts.

• Communicate with the physician offices to report eligibility issues or obtain updated information to complete verification process.

• Identify and understand coordination of benefits when needed.

• Create alert notes on accounts with information that the offices will need to know.

• When insurance has an assigned PCP listed, note this on the accounts.

• Responsible to make insurance changes to all accounts when applicable.

• Notify Account Receivable to review accounts in question when making insurance changes.

• Must be able to keep up with the daily productivity goal for the department.

Location: Onsite 5X a week

Schedule: 8:00am-4:30pm - potential over time (month end closing process)

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