Compliant check on admitted patients' accounts. Insuring account is accurate

Compliance checks all appropriate diagnosis codes and procedures in the order checker system, ensuring that written documentation with the test ordered, diagnosis and physician order is available for Medical Records staff to review.

Completes Medicare Secondary Payer Questionnaire for all Medicare-eligible patients.

Verifies insurance Eligibility and Benefits

Obtain authorizations and pre-certification for all admitted patients as needed per patient insurance plan.

Obtains pre –admission/pre-certifications/insurance verification to support accurate billing and collections. Fully understands and adheres to the rules and regulations of Medicare, Medicaid, Managed Care and Commercial payers regarding pre-authorization, and pre-certification requirements.

Responsible for reviewing and ensuring accuracy of patient’s insurance coverage information, determining primary payer when coordination of benefits is required.

Must be knowledgeable and adhere to all federal guidelines regarding patient registration and reimbursement. Understands inpatient reimbursement and requirements of guidelines per Medicare, Medicaid, Manage Care, and commercial payers. Serves as a resource for others.

Various projects as requested by supervisor