How you'll contribute

• Uses the insurance verification systems to contact the patient and their partner’s insurance to verify benefits, identify benefit maximums, and coordination of benefits.
• Enters information obtained through such contact into the patient and their portal prior to the patient’s first appointment.
• Advises if it is determined that a patient’s benefits do not cover infertility treatment and that they will be in a Self-Pay status, if they wish to receive treatment. Also, inactivates the patient and their partner’s insurance in the billing system, if it is determined that they have no insurance benefits.
• Assists in the maintenance of the patient and their partner’s account by obtaining, accurately recording, and updating personal and financial information as required.
• Ensures all insurance requirements are met, secures payer authorizations with insurance for required services in an expeditious manner, and ensures that all documentation is entered according to division workflow to facilitate information sharing with all staff.
• Documents progress of requests and follow up in information systems until requirement is satisfied and treatment can be approved.
• Enter authorization or precertification information into multiple systems in appropriate location.
• Green light approved treatment cycles in a timely manner.
• Extend expired authorizations when treatment has been delayed.
• Identify any need for peer-to-peer, letter of medical necessity or other documentation to obtain treatment precertification and notify provider immediately.
• Serves as insurance benefits resource to PCC and medical office staff during treatment.
• Maintains confidentiality of patient information and account status.
• Maintains knowledge of and complies with external healthcare industry policies and procedures, including government, insurance, and third-party-payer regulations.
• Monitors Insurance Benefits Verification Representative’s processing of assigned daily activities and partners with the Billing Manager to advise of necessary adjustments to work flow, when indicated, to assure ultimate reimbursement and patient satisfaction scores.
• Identifies and implements opportunities for work redesign/cross-training of procedures that improve the quality and quantity of work processed by Benefits and Authorization Coordinator
• Primary point of contact with office managers when escalated requests or scenarios occur regarding the verification process.
• Contributes to team effort by maintaining an excellent rapport and working relationship with patients, insurance company contacts, nursing staff, office staff, and CEO as needed; cooperating with other departments within the organization.
• Maintains confidentiality of patient information and account status.
• Maintains knowledge of and complies with external healthcare industry policies and procedures, including government, insurance, and third-party-payer regulations.
• Obtaining referrals and pre-authorizations as required for procedures.
• Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
• Will process patients credit card payments and Insurance credit payment. Will post to the patients accounts.
• Identifying and billing secondary or tertiary insurances.
• Will reconcile all credit card charges in Card pointe and provide to accounting.
• Answering all patient or insurance telephone inquiries pertaining to assigned accounts with the best customer service communication tactic.

Who you are

• High School graduate or equivalent
• Bachelor degree preferred or a combination of training and experience.
• Two (2) years of medical insurance/benefits verifications, and experience with requesting Insurance Authorizations. Some experience with Billing functions
• Requires working under stressful conditions or working irregular hours.
• Requires exposure to communicable diseases or body fluids.
• Requires flexibility in changing patient census
• Requires patience, compassion, and the ability to work successfully with a variety of patients, families and employee staff with positive results
• May require critical thinking skills and the ability to work successfully independently or in a team