Financially clears scheduled inpatient and outpatient services, including office visits, testing, diagnostic studies, surgeries and procedures, prior to date of service. Financial clearance process encompasses any or all of the following job functions:
• Verifies insurance eligibility and plan benefits. • Contacts patients with inactive insurance coverage to obtain updated insurance information• Validates coordination of benefits between insurance carriers.• Explains insurance plan coverage and benefits to patients, as necessary. • Secures insurance authorizations and pre-certs for patient services both internal and external to Cooper.• Creates referrals for patients having a Cooper PCP. Contacts external PCPs to obtain referrals for patients scheduled with Cooper providers.• Refers patients with less than 100% coverage to Financial Screening Navigators.• Identifies copayment, deductible and co-insurance information.• Collects and processes patient liability payments prior to service.
Answers a high volume of inbound phone calls in a call center environment, as well as makes any necessary outbound phone calls to payor, providers and patients.
Provides clear and concise documentation in systems.
Communicates daily with insurance companies, internal customers, providers and patients.
Scheduled Days / Hours: M-F 4 hours
High School Diploma required. 2 years insurance verification or registration experience in a hospital or physician office preferred.
Working knowledge of medical insurance plans & products, coordination of benefits guidelines, and requirements for authorizations, pre-certifications and referrals.
Proficiency in working with payor on-line portals, as well as NaviNet, Passport or other third party eligibility systems required.
Experience working in a high volume, inbound call center preferred.
Proficiency in IDX Flowcast, Imagecast, and EPIC EMR systems preferred.