Job Summary:

Responsible for addressing any insurance issues at the beginning of the company's relationship with the patient. The responsibility may or may not include dealing directly with the insurance company in contract negotiations.

Essential Duties:

• Analyze funding of each patient seen daily as well as eligibility information
• Analyze patient registration in computer and verify all insurance information entered correctly as well as diagnosis codes, referring/ordering Physicians NPI and signatures
• Review and Analyze insurance policies to determine whether item will be covered for patient
• Understand and discuss Insurance policies with Practitioners before discussing coverage guidelines with patient
• Educate Practitioners and patients as to responsibilities for obtaining insurance funding
• Speak with patients by phone or in-patient rooms about their payment responsibilities (including co-pays, non-assignment policies, non-covered items, deductibles, ABN's, and payment arrangements)
• Obtain insurance authorizations by submitting requests (faxing auth form, prescription, DWO, clinical codes & pricing) to insurance company and/or PCP (primary care physician) when necessary. Put notes in call back system
• Reviewing, Analyzing and Recording the authorization information in the patients account and/or in the Patient WIP and Opie billing task in the computer
• Releasing requisitions (in Opie with amount funded, and date) for items ordered
• Review information sent by fax to office each day and distribute to correct/appropriate parties
• Assist co-workers with administrative tasks if they are sent to cover other offices
• Assist with all other administrative tasks as needed to decrease workload
• Oversee WIP (work in progress) reports, update and notate with assigned Practitioners weekly
• Back up to Front Desk and Operators
• Analyze and Balance daily Batch Report
• Assist with training new employees and provide ongoing support
• All other tasks assigned by management

Required Skills:

• Knowledge of computers and database/word processing software.
• Knowledge of standard office procedures and equipment.
• Good communications skills.

Education and Experience:

• High School Diploma
• Experience in health insurance authorizations

Mental, Physical & Performance Requirements:

• Abilities in planning, organizing, delegating, and supervising.
• Abilities in evaluating the effectiveness of existing methods and procedures.
• Abilities in problem solving.
• Effective verbal and written communication
• Ability to read, concentrate, interpret, analyze information and apply to procedures -
• Ability to set priorities among multiple requests, keep organized, and adjust to change
• Ability to interact with patients, medical and administrative staff, and the public effectively

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position is in a well-lighted office environment with moderate noise.

Physical Requirements:

• Involves sitting approximately 90 percent of the day, walking or standing the remainder
• Continuous use of hands for keyboarding and data entry

Performance Requirements:

• Attendance onsite mandatory
• Ability to maintain work schedule and handle stamina throughout the day with work flow
• Ability to handle confidential information
• Ability to meet deadlines, adjust to changing requirements, and stress

This is not necessarily an all-inclusive list of job-related responsibilities, duties, skills, efforts, requirements or working conditions. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned.

All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a threat or risk to the health and safety of themselves or other employees. This job description in no way states or implies that these are the only duties to which will be required in this position. Employees will be required to follow other job-related duties as requested by their supervisor/manager (within guidelines and compliance with Federal and State Laws). Continued employment remains on an at-will basis.