Job Description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Verifies insurance coverage/benefits and current patient responsibility utilizing online eligibility, websites or telephone inquiry to the insurance administrator and/or third-party payor and ensures insurance is listed accurately and completely. Initiates, obtains, and documents pre-certification/prior authorizations as required according to Departmental Guidelines.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Verifies insurance coverage/benefits utilizing online eligibility, websites or by telephone inquiry to the insurance administrator and/or third-party payor. Information obtained through insurance verification must always be documented accurately and completely in the EPIC patient billing system. Ensures insurance priorities are correct based on third-party requirements/COB.
• Identifies current patient responsibility using insurance eligibility and benefit responses. Documents patient responsibility as required according to Departmental Guidelines to help ensure correct patient payments are collected at time of service.
• Initiates, obtains, and documents pre-certifications /prior authorizations as required according to Departmental Guidelines.
• Communicates new insurance system issues to appropriate personnel to be reviewed/corrected. Manually corrects/updates current identified insurance issues according to departmental guidelines until correction can be implemented.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Two (2) years billing, bookkeeping, or accounting experience

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Maintains up-to-date knowledge regarding current insurances including but not limited to which plans run through system, appropriate ways to fix errors in the system, and appropriate manners of correctly verifying eligibility and benefits for insurances that do not run through the system.
• Maintains up-to-date knowledge of current managed care contracts and utilizes correct network or out-of-network status for each insurance.

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

Corporate

Department

Pre Access Referrals

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.