GENERAL SUMMARY/BASIC PURPOSE OF JOB:
As part of the Revenue Cycle, the Insurance Verifier is responsible for financial clearance of all patients assigned to their work list/queue. This includes but is not limited to, online eligibility, initiating precertification/authorization, obtaining benefit detail, discussing the patient responsibility prior to arrival and point of service collections. This also includes on-going support of the ancillary services; central scheduling and outpatient registration for add ons, STAT issues or accounts in questions. This role will have a very close working relationship with billing to address denials and appeals as needed.
ESSENTIAL FUNCTIONS AND DUTIES
Run daily work list assignments from Meditech in an effort to ensure all patients are accurately reflected. Cross check this report against the online Meditech work list.
Effective use of the online eligibility system in use including daily review of Loxogon alerts, these alerts should be corrected as close to real time as possible.
Responsible for insurance verification, including authorization, benefits, and eligibility on all patients within the assigned work list at least 1 week prior to arrival. (Exceptions will be granted for add on cases, difficult accounts, etc...)
Ensure an RQI (Radiology Quality Initiative) is secured on specific Blue Cross Blue Shield patients requiring authorization prior to services.
Collaborates as needed with billing on denied claims and appeals in a timely manner in an effort to resolve discrepancies and expedite payment.
Collaborates with ancillary departments and referring clinics to ensure correct services are ordered and authorized prior to the service date.
Efficient use of the charge master within Meditech or any tool in place to determine cost of service and familiarity with contracted survives/insurances.
HIGH SCHOOL DIPLOMA OR G.E.D EQUIVALENT
MINIMUM WORK EXPERIENCE:
A minimum of 2 years working experience with insurance precertification and financial clearance.
Prior physician/hospital scheduling experience preferred.
KNOWLEDGE & SKILLS:
Meditech (preferred B/AR, ADM and PCI modules)
MS Office (word, excel power point, access)
Familiarity with insurance contracts, terms, payment methods and authorization requirements.
Eligibility systems (Ecare/Passport, Loxogon)
Strong insurance background preferred. One year insurance pre-certification experience, medical terminology, CPT & ICD-9 Coding, and Meditech experience preferred.