JOB DESCRIPTION
Summary/Objective
Perform insurance verification and authorizations. Responsibilities include but not limited to heavy phone contact with dental and medical insurance companies, communicate with insurance companies' authorization department regarding any CPT/CDT code discrepancies (as assigned), and contact patient prior to appointment if there are any insurance/ authorization issues. Serves as a valuable resource to patients, providing them with pertinent information regarding their insurance coverage.
Essential Functions (Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions).
- Accurately enter insurance information into computer system.
- Responsible for pre-certification/ authorization and insurance verification for all patients.
- Obtain prior authorization for procedures.
- Research follow up and resolve open & pending authorizations in a timely manner.
- Calculate cash estimates for patients on upcoming visits/ procedures.
- Contact patients regarding financial obligations and arranging payments.
- Documents activity in the patient accounts.
- Concisely, precisely and accurately document all information.
- Maintain clear communication with patients as well as insurance companies.
- Maintain strict confidentiality of patient and center related business.
- Scanning medical documents into patient accounts.
- Answer questions from clinics, patients, insurance companies, and staff.
- Maintain patient confidentiality and adhere to HIPAA guidelines / regulations.
- Perform tasks based on set task schedule.
- Perform general office duties as needed.
Competency
- Customer/Client Focus.
- Stress Management/Composure.
- Results Driven.
- Technical Capacity.
- Problem Solving/Analysis.
- Teamwork Orientation.
- Collaboration Skills.
- Time Management.
- Communication Proficiency
Supervisory Responsibility
This position has no direct supervisory responsibilities.
Work Environment
This job operates in a professional office environment or can be located remotely in a professional home office. This role routinely uses standard office equipment.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; talk or hear. The employee must occasionally lift or move office products and supplies, up to 20 pounds.
Position Type/Expected Hours of Work
Full time, day shift, Monday through Friday. This position may have occasional overtime.
Travel
This position requires no travel.
Required Education and Experience
- High School Diploma or Equivalent
- Ability to effectively handle multiple responsibilities simultaneously in a deadline driven environment.
- Strong understanding of benefits investigating; deductibles, co-insurance, out of pocket expense & benefit exclusions
Preferred Education and Experience
- Associates degree
- Additional coursework in medical/dental billing
- Previous experience with medical/dental billing software systems
- 3-5 years in a fast-paced medical/dental office environment
- Knowledge of patient registration, scheduling, authorizations, billing, and dental/medical policies
- Working knowledge of Medicare, Medicaid, BC/BS, Workers Compensation, Managed Care, and Commercial insurance carriers billing regulations
- Strong organization, problem-solving and communication skills
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