Job Description
Role Description
- This role involves verifying insurance eligibility and benefits for services, ensuring compliance with payor requirements, and communicating financial responsibilities to patients.
- Verifies insurance eligibility and benefits for scheduled and unscheduled services
- Calculates and communicates the patient’s estimated financial responsibility for scheduled services
- Identifies and ensures authorization and referral requirements are met in accordance with payor guidelines
- Validates and documents all authorizations and referrals according to established policies
- Reviews and determines the medical necessity of scheduled services based on payor criteria
- Accurately documents and maintains all required records and communications in compliance with organizational standards
- Communicates effectively and professionally with patients, physicians, and medical office staff to resolve inquiries
- Educates patients on insurance coverage, benefits, and financial responsibility
- Processes and indexes incoming orders promptly and ensures compliance with documentation standards
- Provides timely notification of admission or observation status per payor guidelines for inpatient and observation services
- Performs other duties as assigned
- Complies with all policies and standards
Company Description