Integrated Resources
Duties:
Job Summary: -This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. -Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. -Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. -Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires.
Essential Job Duties: -Obtains insurance eligibility and benefit information using various phone and on-line resources. -Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed. -Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe. -Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement. -Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement. -Immediately refers "at risk" admission to eligibility, i.e., out of network, underinsured, max benefits, etc. -Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays. -Maintains a satisfactory level of performance and adherence to workload standards. -Estimates cost of service using ICD-9 or CPT codes. Performs calculations using insurance benefit information to accurately estimate patient responsibility. -May lead and/or train new employees in account preparation and review functions.
Skills:
Required Skills & Experience: -Two years of customer service experience. -Demonstrated good communications and computer skills. Physical Requirements: -Interact with others requiring the employee to communicate information. -Operate computers and other office equipment requiring the ability to move fingers and hands. -See and read computer monitors and documents. -Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Preferred Skills & Experience: -Demonstrated knowledge of medical terminology. -Experience in admitting, billing, collections, and/or insurance verification. -Bi-Lingual Spanish speaking. -Demonstrated knowledge of CPT/ICD-9 codes.
Job Summary: -This position is responsible to obtain insurance eligibility and benefits information and obtain required authorizations. -Reviews all insurance eligibility responses and communicates with the physician's office and insurance companies as needed regarding these responses or to obtain correct information. -Works with Utilization Review staff to ensure authorizations cover services needed. May also estimate cost of service and patient's responsibility. -Refers patients with questionable insurance coverage to the Eligibility Counselors. May assist in mentoring new hires.
Essential Job Duties: -Obtains insurance eligibility and benefit information using various phone and on-line resources. -Obtains appropriate authorizations and notifies insurance companies of patient arrival as needed. -Works with Utilization Review staff and/or physicians' offices to assure eligibility and authorization requirements are completed within the required timeframe. -Communicates with the appropriate nursing and/or billing staff when changes are made to the account that will affect the reimbursement. -Makes appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement. -Immediately refers "at risk" admission to eligibility, i.e., out of network, underinsured, max benefits, etc. -Works with insurance eligibility responses and other appropriate reports and works with physicians and patients as needed to resolve issues and prevent billing delays. -Maintains a satisfactory level of performance and adherence to workload standards. -Estimates cost of service using ICD-9 or CPT codes. Performs calculations using insurance benefit information to accurately estimate patient responsibility. -May lead and/or train new employees in account preparation and review functions.
Skills:
Required Skills & Experience: -Two years of customer service experience. -Demonstrated good communications and computer skills. Physical Requirements: -Interact with others requiring the employee to communicate information. -Operate computers and other office equipment requiring the ability to move fingers and hands. -See and read computer monitors and documents. -Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Preferred Skills & Experience: -Demonstrated knowledge of medical terminology. -Experience in admitting, billing, collections, and/or insurance verification. -Bi-Lingual Spanish speaking. -Demonstrated knowledge of CPT/ICD-9 codes.