- Verifies and updates patient registration information in the practice management system.
- Obtains benefit verification and necessary authorizations (referrals, precertification) before patient arrival for all ambulatory visits, procedures, injections, and radiology services.
- Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
- Creates appropriate referrals to attach to pending visits.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
- Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
- Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. For primary specialty office visits, fax referral/authorization forms to PCPs and insurance companies in a timely fashion.
- Reviews and notifies front office staff of outstanding patient balances.
- Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
- Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
- Identifies and communicates trends and/or potential issues to the management team.
- Index referrals to patients account for existing patients.
- Create new patient accounts for non-established patients to index referrals.
- Assist in training new team members as directed
- Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
- Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
- Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
- Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.
EDUCATION
- High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
- Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.
- Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
- Working knowledge of Centricity Practice Management and Centricity EMR a plus.
REQUIREMENTS
- Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.
- In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.
KNOWLEDGE
- Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.
- Knowledge of government provisions and billing guidelines including Coordination of Benefits.
- Advanced computer knowledge, including Window based programs.
SKILLS
- Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
- Skill in using computer programs and applications.
- Skill in establishing good working relationships with both internal and external customers.
ABILITIES
- Ability to multi-task in a fast-paced environment.
- Must be detailed oriented with strong organizational skills.
- Ability to understand patient demographic information and determine insurance eligibility.
- Ability to type a minimum of 45 wpm.
ENVIRONMENTAL WORKING CONDITIONS
- Normal office environment
PHYSICAL/MENTAL DEMANDS
- Requires sitting and standing associated with a normal office environment.
- Some bending and stretching are required.
- Manual dexterity using a calculator and computer keyboard.