Confirms and communicates insurance profiles for all patients scheduled for surgery/procedures at Emerald Coast Surgery Center. Provides Financial counseling; communicating to patient’s their responsibility as it applies to deductibles, co-pays, co-insurances; confirming payments are made at time of service. Updates existing patient accounts information in regard to insurance profiles. Works with the AR Manager to achieve payment for primary claim submission within industry benchmarks. Supports the Objectives and Philosophy of Emerald Coast Surgery Center and White-Wilson Medical Center.
Responsible for the accuracy and timely completion of all insurance verification responsibilities assigned by the computer system originating from the Daily Scheduling Work Flow.
- Monitors changes in Work Flow during the day to facilitate add-on case management in a timely manner.
- Ensures resolution of conflicting insurance information when presented during the verification of patient insurance information, informing physician’s offices, seeking timely clarification from all sources including physician office, patient, and/or insurance company.
- Proficient at navigating multiple insurance sites to assure all information is accurate, reading all disclaimers and understanding the various impacts on the planned procedure as it applies to each insurance payer profile for each patient profile-such as screenings for GI procedures.
- Runs the Estimator task within the software for each scheduled case, cross reference with free hand calculations to ensure figures and contract estimates are in line with expectation as needed. Notifies AR Manager immediately when conflicts are discovered.
- Verifies workers compensation authorizations, Motor Vehicle Accident policy injury funds availability, obtaining insurance carrier information such as date of accident, case manager/adjuster’s name, contact information, claim/authorization number.
- Assures documentation of authorization or letter of approval is provided by the case manager/adjuster prior to date of service and part of the record.
- Ensures correct documentation of all Military/VA case profiles (Triwest/Standard/ChampVA) to ensure claims are sent to correct address, confirms authorizations are active for the time period the procedure is scheduled.
- Calculates quotes as directed by facility Policy for all self pay, and cosmetic procedure cases including anesthesia as needed.
- Ensures all quote documentation is prepared in a timely concise manner allowing for priority communication of calculations directly to physician’s office and/or patients as a priority.
- Communicates directly to self-pay and cosmetic patients their financial responsibility, informing patients that payment is due 24-48hrs prior to day of service.
- Prepares ABN and includes ABN in all insurance/cosmetic quotes, providing patient with a full understanding of reason for facility’s need and securing signature.
- Verifies physician’s office cross coding for Diagnosis and CPT procedure are appropriate for utilization purposes.
- Directly inquires need for precertification and/or authorization from commercial insurance, HMO, and Medicaid vendors.
- Communicates with Physician’s office the need for precertification/authorization; obtaining the precertification/authorization numbers prior to DOS, securing information with timely computer data entry.
- Ensures that all insurance coverage is active within the DOS timeframe.
- Communicates directly with patient delinquent account balances (bad debt), tracks to confirm payment in full has been paid prior to upcoming DOS. Communicates to AR Manager/Administrator when patient is unable to pay (bad debt)
- Provides accurate policy payment information using computer estimator and, based on analysis, defining financial amounts for components (deductible, co-pay, and coinsurance).
- Reviews estimated fees and coverage available with the patient/family, explaining the fees and reimbursement process; documents the review in the patient case/insurance tab for the DOS.
- Provide suggestions when patient/family express challenges to meeting financial responsibilities, such as alternative payment options (Care Credit) and works to obtain solutions that maximize benefit to facility’s AR.
- Establishes payment plans for patients when approved by Administrator.
- Receives payments from patient and/or statement recipients
- Maintains strict confidentiality.
- Consistently displays a positive attitude and demonstrates a personal commitment to excellence.
- Performs other duties as assigned.
- Remains proactive in regard to provider’s schedules, verifying insurance and notifying receptionist when patients need to visit patient accounts.
- Determines and collects patient Share of Cost for upcoming procedures. Verifies patient insurance. Uses Availity or calls insurance company to determine patient coverage for procedure (CPT) codes. Informs patient and collects SOC for procedure. Return completed paperwork to physician office. Documents in patient chart.
- Consistently documents all conversations of record by utilizing software system tools and “notes” for accurate record keeping of all discussions with insurance vendors, and patients/family.
- Assists with training current team members of the business office and new employees not only in regard to insurance but all areas of knowledge, ensuring the business office team’s ability to adequately function when individual team members are unavailable to the facility.
- Willing to cross train into other areas within the Business Office.
- Consistently demonstrates the ability as a professional to be an integrated member of the business office team meeting all additional responsibilities as assigned to the business office. Example (phone calls, inter-department communication needs, patient registration, specimen/imaging delivery, scheduling, medical record management, etc).
- Regular and reliable attendance required to team meetings.
- Required to maintain active BLS certification.
KNOWLEDGE AND SKILLS:
To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.
- Possesses strong initiative to get daily work accurately finished and processed.
- Attention to detail is a character strength.
- Proficient in understanding and navigating all health insurance profiles
- Familiarity with CPT coding and ICD-10 formats.
- Possesses strong functional knowledge of accounting principles as they relate to individual account management.
- Possesses strong understanding of Patient Bill of Rights, Responsibilities and HIPAA.
High School Diploma or GED equivalent. BS degree preferred.
Minimum three years in medical business office environment preferred.
Previous responsibility specific to healthcare insurance, verification, authorization process.