Ensure all records are maintained in absolute integrity and in compliance with applicable regulations and requirements.
Obtaining required referrals and authorizations via phone, fax, on-line, etc.
Review reports daily for patients requiring authorizations, pre-notification, and insurance benefit verification.
Obtaining retro-authorizations or updating existing authorizations in a timely manner.
Data entry in a fast-paced environment with high expectation on accuracy.
Updates the patient account with details of the insurance verification.
Coordinating with patients regarding their insurance benefits.
Identifies deductibles, co-pays, and self-pay accounts.
Notifying the appropriate staff members if treatment or service is denied.
Re-verify patients monthly for active, current insurance.
Assist manager and other staff with account questions when presented.
Perform other duties as assigned.
Relies on experience and judgment to plan and accomplish goals.
EDUCATION: High School, with 1-2 years experience in healthcare insurance billing and verification, collections and/or authorizations.
Knowledge of clinic policies and procedures.
Knowledge of managed care contracts and utilization.
Knowledge of computer systems, programs and spreadsheet applications.
Knowledge of medical terminology.
Knowledge of CPT/ICD-10
Skill in gathering and reporting claim information.
Skill in solving utilization problems.
Skill in written and verbal communication and customer relations.
Ability to work effectively with medical staff and external agencies.
Ability to identify, analyze and solve problems.