Insurance Agency Professional

Responsible for verifying patient insurance and benefits and obtaining prior authorization for scheduled medical services and hospital admissions following payer specific guidelines. Responsible for ensuring urgent/emergent cases are worked within one business day of admission and all elective cases worked prior to date of service.

Serves as work resource and liaison to hospital departments, physician offices, and patients for pre-service authorizations or financial responsibility questions.

reports safety and customer concerns.

Maintains productivity and quality standards as defined through the organizational and departmental goals and objectives.

Verifies third party insurance coverage from daily admissions and scheduling databases; including contacting ordering physician's office for missing insurance and procedure information and updates appropriate software systems.

Serves as work resource and liaison to hospital departments, physicians' offices, and patients for pre-service authorization or financial responsibility questions.

Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; Submits patients supporting medical records and necessary information to payer authorization representatives for prior authorizations via fax, phone or online portals.

notifies CM about Medicare Dental Carries patients.

Accurately and completely documents all actions taken regarding the prior authorization process including the authorization numbers, authorized dates and other applicable information in the applicable computer systems.

Maintains accurate payer website information and logins to ensure the most current information is obtained for the necessary authorization requirements.

Supports the financial goals of Bryan Medical Center by communicating with patients and their insurance companies to obtain pertinent information about procedure reimbursements and patient responsibilities.

Communicates with Patient Financial Services regarding denials and appeals/reconsideration letters received from payers.

Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

Participates in meetings, committees and department projects as assigned.

Performs other related projects and duties as assigned.

(High school diploma or equivalency required. Certified Medical Assistant or Licensed Practical Nurse preferred. Minimum of one (1) year of relevant work experience (i.e. hospital billing, coding or prior pre-authorization experience) preferred. Must be 19 years of age to witness legal consents.