MAJOR FUNCTION: 

Ensure patients' health care benefits cover inpatient admission and/or observation stay. Verify patient eligibility and benefit coverage. Submit hospital Notice of Admission for all emergent admissions and observation stays from the day before, in order to obtain required insurance authorizations.
  

QUALIFICATIONS:

Education & Experience:

High School Diploma or GED equivalent required.       Minimum of one year of experience working with medical insurance plans and products, coordination of benefit guidelines, and requirements for authorizations. Minimum of one year of experience working in a hospital or physician office verifying medical insurance coverage and a working knowledge of insurance plans and products, benefits and authorization processes.

Certification/Licensure:  

N/A

Knowledge & Skills:

Must recognize inaccurate insurance information and take an investigative approach in following up as necessary to uncover correct information. Proficiency in working with payer on-line portals ex: Medicare, Medicaid, NaviNet preferred along with working knowledge of Commercial Insurances and Mental Health benefits. Basic knowledge of medical diagnoses and procedure codes required. Excellent verbal and written communications skills. Ability to organize accounts, work independently in addition to being detailed oriented is a must. Must be able to work many accounts daily. Strong computer skills with a working knowledge of Microsoft Office, Excel, Soarian Financials preferred.

Physical Requirements: 
N: Never       O: Occasionally (<20%)       F: Frequently (20%-80%)       C: Constantly (>80%)

Lifting <20lbs

O

Standing

O

Sitting

C

Lifting 20-50lbs

O

Climbing

N

Kneeling

O

Lifting>50lbs

N

Crouching

O

Reaching

F

Carrying

O

Hearing

C

Walking

O

Pushing

O

Talking

C

Vision

C

 

Environmental Conditions:

Noise

O

Varied Temperatures

O

Cleaning Agents

N

Noxious odors

N

Patient Exposure

F

Operative Equipment

N