Insurance Verification Clerk

WEBSTER, TX United States

JOB SUMMARY

Responsible for verifying benefits prior to procedures and notifying the patient of financial responsibility.  Maintains information in an organized manner and obtains pre-authorization for procedures as required by the Insurance Companies.

Reviews financial obligation with patient and family member.  Responsible for sending proper documentation to billing department.  Prequalifies third party coverage of scheduled procedure.  Assists

in the collection and follow-up of patient survey responses.  Performs duties of Admitting Receptionist in absence of Admitting Receptionist.

Reports:          Business Office Manager

Supervises:     None

QUALIFICATIONS

  • High School graduate required
  • Four years of medical facility or medical business office experience required
  • Experience in customer relations or teaching preferred
  • Experience in third party payer requirements preferred
  • Automated billing systems experience required
  • Training/experience in business office activities preferred
  • Requires frequent and constant judgement for timely response to patient questions and concerns.
  • Requires language skills adequate for effective written and interpersonal communication in American English.
  • Require visual and auditory acuity adequate for frequent use of computers and occasional use of other business office equipment.
  • Ability to sit for long periods and to perform desk and office activities.

OCCUPATIONAL EXPOSURE

Category III exposure to bloodborne pathogens may encounter chemical hazards.

RESPONSIBILITIES

Communication Responsibilities to include, but not limited to:

  1. Reviews prequalification for third party payoy before date of scheduled admission.
  2. Reports regularly to the Business Office Manager about the status of current projects or workflow.
  3. Communicates pertinent information from the physician, support staff, insurance companies and other significant parties to the patient.
  4. Answers patient and family member questions and refers questions to healthcare professionals when appropriate.
  5. Discusses documentation with patient and family member confirming that instructions are understood and questions answered.
  6. Maintains current materials for patient education and consent procedures.
  7. Provides documentation for surgical and special procedure patients.

Counsels patients about Facility charges, insurance coverage and the intra-operative experience.

  1. Discusses financial obligations with the patient or family member, explaining the fees and reimbursement process
  2. At patient request, provides a written explanation of estimated fee schedules prior to surgery and documents it in the patient's medical record.
  3. Determines patient qualification for coverage by third party payer and informs patient or family member of status; if patient is not covered, arranges for payment.
  4. Forwards all financial documentation to billing department.
  5. Assists in planning a payment schedule for the patient.
  6. Completes data entry of patient cost sheets, if applicable.
  7. Reviews forms for patient signature; obtains forms or signature(s) as needed.

Evaluates the educational and counseling programs to identify areas for improvement.

  1. Reviews the outcome of teaching and counseling programs as reflected in the patient's overall satisfaction and compliance.




JOB CODE: 1000088