Insurance Verification Authorization

Summary

Under direct and indirect supervision of the Billing /Insurance Manager and/or Executive Director accurately and efficiently verify patient insurance benefits and obtain necessary authorizations and referrals for services rendered at MRI & CT Diagnostics. Confirm deductibles co-payments cost-shares and patient responsibility in a polite and professional manner.

Major Job Functions

• Verify insurance coverage and benefits for all scheduled patients at least 24-48 hours in advance

• Confirm accurate billing address of carrier and contact person when appropriate

• Confirm patient demographics referring physician information and other chart information is accurate

• On behalf of the referring physician obtain authorization for services from insurance company if required

• Process patient and insurance carriers telephone calls

• Contact patient and/or referring physician when insurance coverage cannot be verified

• Notify patient of any co-payments cost-shares or deductibles

• Communicate with Scheduling Department when authorization cannot be obtained

• Communicate with the front desk of any special circumstances

• Properly notate accounts of all communications with patients

• Assure that copies of all referrals written authorizations and authorization numbers are entered in patient RIS record and provided to the billing department

• Obtain necessary clinical records to facilitate obtaining authorization

• Contact attorney verify representation and billing address date of accident or injury. Instruct front desk personnel to obtain patient signature on lien letter

• Review authorization letters for accuracy

• Refer patients with special payment circumstances to management

• Communicate changes with insurance companies requirements with staff and management

• Maintain the current exam board as well as the pending board

Additional Statement

A review of this description has excluded the marginal functions of the position that are incidental to the performance of the fundamental job duties. All duties and requirements are essential. This job description in no way states or implies that these are the only job duties to be performed by the employee occupying this position. Employees will be required to follow any other job related instructions and to perform any other job-related duties requested by their supervisors and/or management as required.

MRI & CT Diagnostics reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment for any term.

Qualifications

• High School Diploma

• Previous healthcare experience preferred with courses in medical terminology preferred

• Ability to operate copier FAX machine and computer

• Must have excellent organizational communication and interpersonal skills.

• Ability to set priorities and manage varying workload

Specifications

• Must be able to remain calm in stressful situations. Must display courtesy and empathy toward co-workers and physicians. Must be able to make sound judgments and execute the appropriate actions based on the needs of the knowledge of departmental policies and procedures.

• Must be discrete with confidential information and abide by corporate HIPAA policies.

• Must be able to move about freely. Sits stands walks intermittently during the day.

• Must possess sufficient visual and auditory acuity and manual dexterity to perform task.

• Must attend mandatory practice training and departmental requirements annually.