Insurance Eligibility Clerk

JOB DESCRIPTION

POSITION: Insurance/Eligibility Clerk

DEPARTMENT: Front Office

REPORTS TO: Front Office Supervisor

Job Summary: This individual is primarily responsible for pre-determination of benefits, obtaining prior insurance approvals, authorizations, and/or referrals for incoming patients.

Education and Experience:

1. High school diploma or equivalent.

2. Two years minimum experience in medical office, (healthcare) insurance experience preferred.

Essential Skills and Abilities:

1. Excellent communication skills, written and oral.

2. Strong organization skills with attention to detail.

3. Excellent follow-up skills.

4. Management of multiple tasks simultaneously.

5. Diligent in routine tasks.

6. Ability to work as a team player.

RESPONSIBILITIES:

1. Authorizations

a. Contacts insurance companies requesting policy effective/termination dates, deductible/out-of-pocket accumulations, and pre-existing clauses on all upcoming office visits, testing, and procedures.

b. Obtains authorizations for any procedure (usually those procedures in excess of $200) or appointment requiring prior approval.

i. Contact patient to make them aware of required referral authorizations.

ii. Contact patient’s PCP to request referral authorization when required.

iii. Contact insurance companies to confirm referral authorizations have been approved.

iv. Enter referral authorization information into system and scan documents as necessary.

c. Obtains approval for all emergency services from any insurance company - whether contracted or not.

d. Contacts patients if/when additional insurance information is necessary.

e. Contacts patients if/when collection of payment is necessary (usually those unrelated to copay costs).

2. Claims: Preparation and Filing

a. Submit medical documentation for TriWest and Veteran’s Administration claims.

3. Administrative

a. Answer telephone calls promptly (within two rings) and addresses caller’s reason for call.

b. Schedule appointments with the appropriate physician to ensure top quality care to patients.

c. Directs calls/takes messages for techs, doctors, or other office personnel.

d. Scanning appropriate documents.

e. Post incoming patient payments.

f. Work-up and post patient refunds.

g. Fill check-in reception as required.

h. Assists other front office personnel as time and demand require.

Performs other duties as required.

Job Type: Full-time

Pay: $14.00 - $18.00 per hour

Benefits:

• 401(k)
• Health insurance
• Paid time off

Work Location: In person

Salary : $14 - $18