To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
DUTIES AND RESPONSIBILITIES
- Responsible for obtaining complete and accurate insurance information, benefit verification, accurately interpreting benefit plans and investigating pertinent details. Notifies supervisor of known or potential insurance coverage issues.
- Review information for admission and continued visit management including type and duration of service, authorization and treatment codes, re-authorization and continued visit requirements necessary for ongoing treatment and payment.
- Responsible for explaining benefits, the billing process and financial responsibility to parent/guardian.
- Responsible for obtaining and communicating pre-authorization as needed per insurance company requirements.
- Responsible for tracking, obtaining and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed. Appeals for additional services (extended stays, visits, authorization extension, letter of medical necessity) and refers to additional resources when necessary.
- Record insurance information to maintain data through the Referral/Insurance Verification process and communicates insurance information to pertinent staff including therapists, coding and finance. Independently maintains and works from the electronic medical record and additional databases.
- Responsible for sending the Plan of Care/Certification Letter after an evaluation, secondary to any changes and annually and for obtaining a signed copy for the medical record.
- Track a significant amount of data and information, preparing and producing meaningful reports and information.
- Assist with the effective management of all incoming referrals and the transition of inquiries to the appropriate service lines within the organization.
- Assist with greeting incoming patients, completing/distributing paperwork, entering pertinent patient information into the electronic medical record, and verifying insurance eligibility.
- Other duties as assigned/ required.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.
High school diploma/GED required
Minimum two (2) years insurance resolution experience resolving issues with patients
Exceptional organization skills
Strong attention to detail
Excellent interpersonal and organization skills
Proficient in computer programs, including Microsoft Office and Outlook
Knowledge of medical terminology
Demonstrate knowledge of state, federal, and third party claims processing required
Location/Region: Covington, LA (US - 70433)