Patient Financial Services

Job Description

Job Description

Required Qualifications

• Experience using insurance verification resources such as Availity, Experian Health, Inovalon, Medicare resources, or payer-specific portals.

• Ability to independently contact insurance payers by telephone or through direct payer portals when electronic verification tools are unavailable.

• Proficiency with Windows-based computer systems; Microsoft Word and Excel familiarity helpful.

• Cerner experience preferred but not required.

Other Requirements:

• Strong attention to detail and ability to accurately interpret insurance benefits and payer requirements.

• Ability to independently manage verification and authorization workflows while meeting departmental deadlines.

• Strong written and verbal communication skills.

• Ability to work independently and collaboratively while maintaining confidentiality.

• Ability to maintain accuracy and productivity in a high-volume healthcare environment.

Key Responsibilities

• Perform comprehensive pre-service insurance eligibility and benefits verification for scheduled inpatient and outpatient rehabilitation services.

• Review insurance coverage for physical therapy, occupational therapy, speech therapy, and other rehabilitation services.

• Identify payer-specific coverage requirements, authorized visit limits, annual benefit limitations, and restrictions affecting recurring treatment appointments.

• Determine insurance coverage, expected payer payment, and patient financial responsibility, including applicable deductibles, copays, and coinsurance.

• Identify when prior authorization is required and obtain necessary authorizations before scheduled services.

• Access Availity, Experian Health, Inovalon, Medicare resources, and payer-specific portals to verify benefits and coverage.

• Contact insurance carriers directly by telephone or through payer portals when electronic verification systems are unavailable or information requires clarification.

• Review scheduled patient information from departmental tracking tools and complete necessary pre-service financial clearance activities.

• Communicate with physician offices, clinical teams, and internal departments to obtain information needed for verification and authorization.

• Assist patients in completing charitable applications at the medical centers.

• Accurately document verification findings, authorization details, visit limitations, and patient financial responsibility.

• Follow up on outstanding pre-service verification or authorization items and escalate unresolved issues appropriately.

• Maintain confidentiality, accuracy, and productivity while supporting efficient rehabilitation operations.

• This position focuses on pre-service insurance benefits verification and prior authorizations. Billing, claims processing, and denials follow-up are handled by separate teams.