Job Description
Job Description
Responsible for the insurance re-verification process of patients and their insurance companies, federal agencies and third-party payers. Communicates and obtains signed start of care documentation from patients, caregivers, responsible parties. Audits patient accounts to ensure accuracy and clean claims. Coordinates receipt of information with internal departments. Shows concern and respect for others by dealing with people in a compassionate, sensitive and responsive manner. Performs a variety of tasks under general supervision. A certain degree of creativity and latitude is required. Additional dimensions may include working with operating budget, revenue responsibility, purchasing responsibility, etc. Ensures company’s goals and objectives are aligned with the organization’s broader mission, vision, and driving strategies.
MAJOR DUTIES AND RESPONSIBILITIES:
1. Answers telephone utilizing appropriate etiquette and speaks with general public, referral sources, payors, clinician's patients and their families.
2. Verifies insurance coverage on a monthly basis prior to deliveries to ensure active coverage is in place. Notifies internal departments and patients of any and all changes in policies, or benefit termination.
3. Confirms that services to be provided by company are a covered benefit under patient's insurance coverage.
4. Completes start of care paperwork, Financial Obligation Form, Medicare/Medicaid forms as needed. Forwards the necessary paperwork to Pharmacy department for delivery, or via mail (electronic or postal).
5. Obtains and documents in the system all information related to coinsurance, copay, deductibles, authorization requirements, etc.
6. Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines
7. Tracks and obtains patient start of care paperwork to ensure all records are compliant. Creates additional documentation as required to service the patient per policy and payer guidelines.
8. Acts a liaison between reimbursement and Central Intake and Reauthorization Department when necessary for complex case resolution.