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Verification of insurance coverage utilization different on-line modalities for clinic patients receiving diagnostic testing (i.e. CT, MRI, etc.),along with chemotherapy and radiation therapy and/or surgical procedures. The associate is responsible for obtaining prior authorization requests and/or pre-determination for these services to ensure maximum reimbursement to the organization.Minimum Required: High School Diploma or GED. | Minimum Required: 1 - 2 Years equivalent experience completing Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access or similar environment.
• Preferred: 3 - 5 Years equivalent experience completing Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access or similar environment.OUTPATIENT SUPPORT FUNCTIONS.
1. CONDUCTS PRE-REG ON ALL POTENTIAL NEW REFERRED PATIENTS, VERIFIES INSURANCE AND ALL DEMOGRAPHIC INFORMATION
2. REGISTERS NEW PATIENTS AS THEY ARRIVE
3. COMPLETS ALL NEW PATIENT PAPERWORK WITH PATIENT OR FAMILY
4. SCANS FORMS AND DOCUMENTS ON ALL EFFORTS DEEMED NECESSARY IN THE ATTEMPTS TO SECURE FORMS
5. GOOD COMMUNICATION SKILLS, ORGANIZATINAL SKILLS AND EPIC KNOWLEDGE
6. WORKS WORKQUES TO ENSURE THERE ARE NO DELAYS IN BILLING OR REIMBURSEMENT
7. EXPECTED TO MAINTAIN PRODUCTIVITY

8. CALL CENTER PHONE LINES, HANDELING PATIENT CALLS AND SCHEDULING ON ALL INCOMING REFERRAL WORKQUES.
9. ASSISTS WITH DOCUMENTING, SCANNING AND DISTRIBUTING MAIL.

10. SCHEDULES FOLLOW UP APPOINTMENTS AS DIRECTED FROM THERAPIST.

Insurance Verification:

Initiates on-line verification and/or makes phone contact with Insurance Carriers and Plan Administrators to verify patient benefits to precert all outpatient services are secure.. Ensures authorization has been obtained for all scheduled and non-scheduled high dollar outpatient procedures. Follows up on missing data or problem accounts.

Documentation:

Documents complete and accurate data relating to all necessary eligibility, benefits and precertification information in appropriate Epic database fields. Informs management of trends of incomplete data, registration issues, etc.

Worklists:

Effectively organizes prioritization of Daily Worklist task.

Secure Accounts:

Secures all applicable accounts in timely manner as defined by Due Diligence Standard while maintaining department productivity and quality standards.

Communication:

Reports improvements, problems and changes as it relates to insurance verification to department management.

Other duties as assigned:

Performs other duties as assigned.OUTPATIENT SUPPORT FUNCTIONS.
1. CONDUCTS PRE-REG ON ALL POTENTIAL NEW REFERRED PATIENTS, VERIFIES INSURANCE AND ALL DEMOGRAPHIC INFORMATION
2. REGISTERS NEW PATIENTS AS THEY ARRIVE
3. COMPLETS ALL NEW PATIENT PAPERWORK WITH PATIENT OR FAMILY
4. SCANS FORMS AND DOCUMENTS ON ALL EFFORTS DEEMED NECESSARY IN THE ATTEMPTS TO SECURE FORMS
5. GOOD COMMUNICATION SKILLS, ORGANIZATINAL SKILLS AND EPIC KNOWLEDGE
6. WORKS WORKQUES TO ENSURE THERE ARE NO DELAYS IN BILLING OR REIMBURSEMENT
7. EXPECTED TO MAINTAIN PRODUCTIVITY

8. CALL CENTER PHONE LINES, HANDELING PATIENT CALLS AND SCHEDULING ON ALL INCOMING REFERRAL WORKQUES.
9. ASSISTS WITH DOCUMENTING, SCANNING AND DISTRIBUTING MAIL.

10. SCHEDULES FOLLOW UP APPOINTMENTS AS DIRECTED FROM THERAPIST.

Insurance Verification:

Initiates on-line verification and/or makes phone contact with Insurance Carriers and Plan Administrators to verify patient benefits to precert all outpatient services are secure.. Ensures authorization has been obtained for all scheduled and non-scheduled high dollar outpatient procedures. Follows up on missing data or problem accounts.

Documentation:

Documents complete and accurate data relating to all necessary eligibility, benefits and precertification information in appropriate Epic database fields. Informs management of trends of incomplete data, registration issues, etc.

Worklists:

Effectively organizes prioritization of Daily Worklist task.

Secure Accounts:

Secures all applicable accounts in timely manner as defined by Due Diligence Standard while maintaining department productivity and quality standards.

Communication:

Reports improvements, problems and changes as it relates to insurance verification to department management.

Other duties as assigned:

Performs other duties as assigned.