Position Summary Coordinates aspects of referral, insurance verification, scheduling, and admission of the patient. Ensures services provided to patients meet the standards set by the facility. Obtains all required medical documentation from ordering practitioners. Communicates and provides follow-up to patient on benefit coverage, visit guidelines and limitations. Provides clinicians with proper chart forms and insurance parameters. Reviews patient charts and communicates with clinicians on-going documentation requests from patient’s provider. Works with case managers and insurance payers to achieve optimum continuity of care and assists in appeals process if necessary. Minimum Qualifications Work Experience One year of billing and/or insurance verification experience required.
Education Associate’s degree in business or healthcare related field preferred. Equivalent work experience may be considered in lieu of required education. Bachelor’s degree preferred.
Certifications/Licensure None required. Job Specific Performance Standards The duties listed below are a summary of the major essential functions of this position. The position may require other duties, both major and minor, that are not mentioned, and specific functions may change from time to time.
  Initiates contact with new patients. Coordinates aspects of referral, insurance verification, scheduling, and admission of the patient. Ensures services provided to patients meet the standards set by the facility. Completes or verifies intake information on all referrals. Completes the referral log. Monitors the status of patient’s insurance coverage. Manages visit limit and status. Reviews all elements to ensure insurance criteria are met.  Establishes payment recommendation. Thoroughly documents information into computer system. Communicates and provides follow-up to patient regarding approved visits or benefit limitations. Assists patients in resolving questions regarding insurance coverage. Educates patients and employees on insurance guidelines as related to pre-certifications, deductibles, co-pays, and other benefits.  Verifies the patient account has been registered correctly and consent information is loaded, and appointment reminders are established. Prepares charts with outcome measures per diagnosis, treatment forms per modality, and charge ticket per payor. Ensures that all medical documentation received is complete, accurate and placed in the patient chart appropriately.