Description

JOB PURPOSE: Contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements for basic and moderately complex hospital outpatient visits. Obtains pre-certification or pre-authorization prior to the scheduled service being performed. Liaisons with physicians and physician office staff when needed to obtain additional demographic, insurance or clinical information. Notifies the payer of admission if required.

KEY RESPONSIBILITIES:
Determines pre-certification, pre-authorization and or medical necessity requirements for hospital procedures and obtains it from insurance companies or payers and how many services covered.
Contacts the physician’s office staff for additional required information pertaining to the visit. I.e. demographics, correct insurance information, or authorization.
Verifies that the insurance or payer coverage is still active and what it covers for the patient.
Obtain, enter, and update demographic and other financial and clinical information necessary for financial clearance of schedule patient accounts.
Ensure all required data elements are collected and validated for account creation in Revenue Cycle systems.
Ability to estimate and collect financial responsibility from the patient.