The Insurance Verifier is responsible for confirming all coverage for patients prior to the day of service. They are also responsible for informing the patients of their coverage including any copays, deductibles and co-insurances due the date of the procedure.
Essential Duties and Responsibilities:
- Verify coverage (ourselves) and obtain and document 100% of required insurance pre-authorizations prior to surgery.
- Call 100% of scheduled patients 3+ days prior to surgery to tell them and document what is owed the day of surgery
- Enter the patients’ insurance information accurately in the computer system.
- Greet the public with a sense of warmth, compassion and pride and see to the needs of the patients and families.
- Obtain insurance information, copies of insurance cards, patient signatures, and collect 100% of the patient’s portion of financial responsibility.
- Document and maintain the daily receipt journal; Copy the patient and hand-off to the Accounts Receivable Representative for posting – daily.
- Answer, screen and route all incoming calls in a professional manner by the third ring.
- Contact the insurance companies to verify coverage and the need for a prior authorization
- Complete letters of medical necessity as needed for insurance companies and keep copies scanned in the patient charts
- Inform patient of self pay rates due in the event the insurance company is out of network for the facility
- Maintain an open line of communication with the Business Office Manager to ensure conflicts between contracted entities and the information being received from the customer service representatives at the payers is accurate
- Know and understand payer contracts and how they read so you can discuss any issues with the customer service representatives when verifying coverage
- Be familiar with state and federal laws and mandates when it comes to coverage by medical payers for the services we provide
- Educate the parents to contact their insurance company if the carrier states its not a covered benefit or to ensure they have an advocate to obtain timely payments for the center prior to date of service
- Scan all authorizations or approvals for the patient surgery into the document manager of the practice management system
- Act as a second signature for deposits prior to going to or coming back from the bank to confirm deposits
- Ask for help when you need it.
- All other duties as deemed appropriate