Position Description: Performs various access-related duties to include but not limited to, eligibility/insurance verification for services , obtaining authorization/referrals , scheduling, canceling, rescheduling, point of service payments, general appointment information and directions.

Reports to: Revenue Cycle Supervisor

MISSION

Provide strong and exceptional customer service skills and ability to follow policies regarding insurance verification. Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits for services and communicate the patient’s financial responsibility. Proactively identifies resources for patients and may communicate the financial resources available to patients whose health plan does not include coverage for services. Ensure the patient’s confidentiality and integrity are maintained to the highest standards.

OUTCOMES

• Interviews patients and/or family members as needed to secure information concerning insurance coverage, eligibility, and qualification for various financial programs.
• Coordinates and performs verification of insurance benefits for every visit by contacting insurance company /website and determining eligibility of coverage and communicates status of verification/authorization/referral process with appropriate team members in a timely and efficient manner
• Provides clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for completion ofauthorization/referral process.
• Acts as a liaison between clinical staff, patients, physician,insurance payor, external vendors (ex: drug reps, pharmacy, ) forming patients of referral or authorization/benefit delays/denials, answering questions, educating patients about their benefit, and offering assistance.
• Maintains tracking of patients on schedule, ensuring that the correct insurance plan, eligibility,referral and authorization information has been entered into data entry systems accurately along with documenting applicable notes or review secure notes.
• Calculate estimated patient responsibility to inform the patient and document in the data entry system.
• Adhere to the Collections Policy to ensure patients are aware that payment is due at time of service and responsible for setting up payment arrangements.
• Collect payment prior to or on the date of service.
• Reschedule/cancel patients in the data entry system accordingly due to verification/authorization related issues

COMPETENCIES

Job Related Competencies: