Insurance Verify Rep

Job Summary

The primary function of this position is to verify insurance for payment of procedures.

Essential Functions

• Interact with physician offices and patients in a timely courteous manner
• Verifies insurance benefits, eligibility, and pre-determination requirements for all scheduled patients
• Verify correct insurance package has been loaded into the patient's chart
• Review provider schedule in electronic medical record and obtain referrals for HMO patients; authorizations for procedures and radiology testing
• Review provider schedules in Hospital Radiology to look for and obtain authorizations for procedures and radiology testing
• Review the Authorization/Referral list in Athena and obtain/attach proper Authorizations and Referrals for pending appointments
• Utilize patient financial system and other computer systems to create the authorizations/referrals and attach to all relevant appointments
• Track and monitor authorizations/referrals to account for benchmark data
• Coordinates with the physician’s office when a required pre-determination has not been obtained
• Contacts patient in advance, notifies of estimated liability and payment options
• Utilize patient financial system and other computer systems to access and update surgery schedules, patient information for registration and up-front patient responsibility
• Answers telephone, questions, and returns calls in a courteous timely manner
• Assists and backs up other business office positions as needed
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED preferred
• 1-2 years customer service required
• 1-2 years health care / medical office experience preferred

Knowledge, Skills and Abilities

• To perform this job successfully, an individual should be proficient at working with computers and Google Suite. Experience working with patient financial systems, specifically patient financial systems (e.g., Athena, Availity, Tricare, ) preferred.
• A good understanding of medical terminology required