Responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures. 

Reports to: Patient Access Supervisor

Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointmentDrag Edit DeleteNotifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointmentDrag Edit DeleteHeavy phone and payer website contact in accordance with payer pre-cert and verification regulationsDrag Edit DeleteCommunicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretionDrag Edit DeletePerforms insurance verification, eligibility and pre-certification for outpatient scheduled procedures.Drag Edit DeleteMaintains current knowledge of outpatient imaging policies and proceduresDrag Edit DeleteVerifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systemsDrag Edit DeleteCommunicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedureDrag Edit DeleteWorks closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them.Drag Edit DeleteCreates and explains patient liability estimate for all scheduled and add-on proceduresDrag Edit DeleteContacts patient or physician offices when insurance information invalid or termed for all scheduled proceduresDrag Edit DeleteProvides registration functions, as needed
Minimum Education
High school diploma or equivalent - RequiredDrag Edit DeleteMinimum Education
Two years of college or medical office specialist education - PreferredDrag Edit DeleteRequired Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Must be able to function appropriately in a multi-task setting. Working knowledge of managed care and third party payorsDrag Edit DeleteMinimum Work Experience
One year experience with obtaining and verifying pre-certifications with various insurance companies Required.
Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran