Job Description
Summary:

This position provides the insurance verification functions for all scheduled and unscheduled patients, by contacting insurance companies, and by utilizing our electronic eligibility system. In addition, this position would analyze the eligibility information, and provide the estimate of the patients' portion per their insurance contract. This position would also pre-certify patient visits with insurance companies when appropriate, and forward information to Case Management for clinical details.

Responsibilities:

• Determines each patient's insurance eligibility and benefits, verifying with the insurance company, employers, or thru our electronic system, within the departmental guidelines
• Identifies accounts that are priority, determined by coverage, date of service, and dollar amount of expected services
• Verifies all insurance for scheduled and unscheduled patients
• Obtains effective dates, correct mailing addresses, obtains pre-certification telephone numbers, and documents all information in the system
• Documents in the system any items that are unique to the coverage, i.e.. pre-existing, limitations, etc. with special attention to the uninsured and credit risk accounts
• Calculates deductible amount due, and any out of pocket amounts such as co-insurance amount or co-payment amount
• Obtains pre-certification for the current visit from the insurance company, along with notifying Case Management if clinical information needs to be provided to complete the pre-certification process
• Contacts pre-certification company to obtain pre-certification number for the visit for the hospital (not the same as the physician's pre-certification)
• Documents the pre-certification/reference number in the system
• Obtains authorization for Medicaid patients when necessary
• Refers all accounts needing clinical information to the Case Management Department
• Corrects financial classes, insurance plans, etc. to assure that the patient's financial record is correct
• Identifies any incorrect insurance plans or financial classes, and corrects them in the system
• Deletes incorrect or changed insurance plans from history in the system
• Corrects Medicaid plans to reflect appropriate plan
• If insurance is verified as having been terminated, documents all information in the system, and changes the accounts to self-pay

Requirements:

Education/Skills

• High School Diploma

Work Type:

Full Time

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Insurance Verification Clerk - Pre-Registration Office Admitting - Full Time

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