INS AUTHORIZATION / BENEFITS COORD

Overview

Coordinates insurance verification eligibility, pre-registrations, and authorizations for hospital services.

The following is a summary of the major essential functions of the job. The incumbent may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time :

Following established policies and procedures, verifies eligibility for patients and ensures all pre-authorizations, referrals, and pre-certifications are obtained as necessary by working closely with the physician offices, Utilization Review and Business Office Departments.

Works closely with the collections department in identifying self-pay patients as well as repeated bad debtors and notifying Financial Counseling.

Estimates patient financial liability for scheduled services and completes Financial Liability Worksheet as appropriate.

Works closely with Utilization Review regarding insured patients to identify insurance coverage and limits. Assists uninsured patients pursuing financial assistance options.

Coordinates appeals denied for no pre-authorization, assisting the patient, physician office and the insurance company.

Assists Registrars when backlogged with patients in registration as necessary.

Acts as back up to Schedulers.

Perform other job-related duties as directed by the Supervisor.

Exemption Status

Non-exempt

Requirements

Education : High School Diploma or GED preferred.

Experience : Minimum two years related experience in admitting or business office.

Knowledge, skills and abilities required :

Knowledge of basic medical terminology and ability to pass related basic spelling test.

Ability to communicate both verbally and in writing.

Ability to type 30 words per minute.

Background of insurance knowledge is mandatory.

Background / knowledge of government / state and patient assistance programs.

Working knowledge of ICD-9 and CPT coding.

Ability to comprehend insurance cards

Ability to deal directly with the public.

Strong computer skills. Proficiency in Windows and Microsoft Office preferred.

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