Job Description

• Verifies insurance benefits
• Processes accounts to ensure that patients are preregistered and required insurance authorization and precertification’s are obtained prior to the date of service.
• Communicates with patients and insurance companies regarding coverage and other related matters. Discusses benefits with patients, responds to patient/third party inquiries.
• Completes insurance verification /pre-certification according to payor requirements: Identifies outpatient procedures that require precertification /second opinion: obtains required information from physician; pre-certifies inpatient admissions.
• Works with financial counselor to request pre-payment and informs patients of discounts
• Completes Medicare Questionnaire; ensures that medical necessity is established for Medicare / Medicaid patients
• Responsible for accurately scheduling diagnostic and/or surgical procedures
• Conducts physician office/patient interviews and explains hospital procedure guidelines and policies
• Responsible for obtaining complete and accurate clinical, demographic and financial information during the scheduling process
• Provides the patient with prep and other appointment instructions
• Follows guidelines for special requires /STAT/schedule modification procedures and coordinates communications with clinical areas to accommodate the patient requests
• Notifies patient of physician order, preauthorization and other financial clearance requirements
• Other duties as assigned

Requirements

Education/Experience:

• High school graduate or equivalent
• Prior medical experience and knowledge of insurance policies and procedures preferred
• Medical terminology preferred

Skills/Abilities:

• Excellent communication and interpersonal skills required to discuss financial matters with patients and/or their representative, and to work with all levels of professionals at JCH and in other organizations.
• Ability to comprehend large amounts of complex information, and explain complex insurance benefits to patients and/or their representatives.
• Ability to respond to quickly changing priorities and patient needs
• Demonstrated computer skills and related experience preferred

Physical Requirements:

• Work is of light demand
• Motor coordination and finger dexterity required to operate computer equipment and other office machines

Benefits:

• Health Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Retirement
• Paid Time Off
• Tuition Reimbursement
• Health Savings Account
• Wellness Program
• Employee Assistance Program