Insurance/Authorization Review

JOB SUMMARY:

Insurance Authorization/Reviewer is responsible for all insurance verification, documentation, obtaining referrals and authorization, notification of benefit and authorization per each insurance provider guidelines

ESSENTIAL FUNCTIONS

o Develops and maintains up to date knowledge of individual insurance program

requirements relative to multispecialty clinic medical services and

Department of Rehabilitation Services.

o Develops strong working relationship with third party payor offices and

physician offices.

o Explains and reviews all insurance requirements with patients to assist them

in understanding the impact of their individual policies on receiving Rehab

services at NWH and are able to successfully obtain all appropriate

paperwork necessary.

o Assists patient in obtaining appropriate paperwork as necessary.

o Obtains and maintains third party payor approval, tracks authorizations and

visits to insure compliance with all third party payor requirements.

SECONDARY RESPONSIBILITIES

o Answers the telephone; takes, screens and relays messages and/or provides

routine information pertinent to operation of Multi-specialty Clinic and

Department of Rehabilitation Services.

o Schedules initial and follow-up appointments for all patients seen in

Department of Rehabilitation Services.

o Transcribes, types, does word processing, data entry, proofreads, corrects,

types and distributes correspondence, reports, patient records and other

materials as necessary for efficient operations.

o Organizes and maintains files, records, logs and other controlling systems;

retrieves files as needed; Communicates needs to health information

services regarding medical records needs for multispecialty clinic and

coordinates activity to assure records available when necessary.

o Sorts, distributes and/or files incoming documents and other

correspondence.

o Reserves rooms and audio visual equipment, as needed.

o Photocopies and releases patient records to third party payors, physicians

and other requesting personnel.

o Greets patients and their families; prepares and assists with all

documentation necessary for completion of chart, insurance

authorization, outcomes analysis and third party payor requirements

for medical specialty clinic and Department of Rehabilitation

Services.

o Prepares documents for treatment and equipment charges to be billed. Does

data entry of charges.

o Reviews copayment information, collects copayments, issues receipts and

maintains appropriate accounting information.

o Performs other duties as assigned.