Description

Summary Works directly with clinic staff and patients to obtain benefits and eligibility and or initiate referral request when needed.

Essential Duties and Responsibilities include the following. Perform other duties as required and or may be assigned.

• Verify insurance benefits and eligibility, inquiring about precertification and authorization if needed.
• Enter and update data such as insurance information and demographics into patients account
• Submit request for needed referrals to appropriate authority or PCP
• Follow up to secure authorization prior to patient appointment to ensure reimbursement
• Be a valuable resource to front office staff and patients 
• Advise clinic staff of any anticipated delays for Referral and or Authorization
• Secure and confirm validity of any referrals and enter them in the patient’s electronic record 

Requirements

Education and/or Experience

• Strong, working knowledge of insurance payers to include government, commercial and managed care products
• Ability to establish a good rapport with outside providers and or clinic staff
• Resourceful, steadfast attitude to make sure that patient needs are met timely
• Comfortable with navigating through the payer websites to secure appropriate benefits
• Excellent verbal customer service communication skills 
• Job requires extensive time on the phone and provider websites daily

Other Qualifications:

• Must have the ability to work on multiple tasks at once
• Required to meet department quality and production standards 
• Must work well in a team environment 
• Ability to communicate well with the patients and other personnel in a tactful and courteous manner
• Maintaining and satisfying minimum attendance requirements is an essential function of this position, including working all full-time regular hours as established for this position
• Computer literate, knowledge of, or ability to learn multiple clinic/hospital software required 
• Protect PHI and follow HIPPA regulations