01Responsibilities
- Work effectively with insurance companies to obtain pre-certification/authorization for services
- Place calls to various health plans to obtain appropriate precertification prior to the patient's appointment
- Ability to understand/interpret documented clinical information and relay pertinent medical/clinical information to the insurance company
- Fax to pre-certification request form to insurance company
- Maintain files and security of confidential information utilizing host system to scan and input data as per established procedures
- Verify medical insurance information and documents in scheduling/registration modules
- Review claim denials and rejections
- Accurately enter and update patient data, and other general data, into the computer system
- Patient intake; insurance verification, notification of copays/patient liability and confirmation of demographics
- Maintain account work progress, including but not limited to updating authorization logs, account referral in EMR, authorization paperwork and issue reports
- Demonstrate knowledge of varied managed care insurance and regulatory guidelines
- Meet and maintain daily productivity/quality standards established in departmental policies
- Use the MPower workflow system, client host system and other tools available to collect payments and resolve accounts
- Adhere to the policies and procedures established for the client/team
- Communicate effectively with physician offices and patients
- Place outbound call to patients with precertification notification
- Work independently from assigned work queues
- Maintain confidentiality at all times
- Maintain a skilled attitude
- Other duties as assigned by the management team
- Use, protect and disclose patients protected health information (PHI) o .
