Responsible for receiving information from referral sources, verifying patient insurance demographic data, determination of correct billable party, accurate and timely entry into patient management system and obtaining pre certification or authorization for services. Working knowledge of HIPAA, Federal, State and Local insurance regulations
Timely processing of initial and ongoing referrals by navigating through established policy and procedures and payer guidelines.
Verifies and updates patient demographic and insurance information in the practice management system.
Effectively use problem-solving skills to obtain and verify patient demographic and insurance information.
Obtains insurance coverage eligibility, benefit verification and accurately determines correct party financially responsible for payment.
Obtains necessary authorizations, referrals, or pre certification.
Review referral submission for accuracy, completeness and all specific billing requirements met.
Resolution of incomplete referrals and/or insurance authorization requests by obtaining and validating necessary information i.e. demographic, financial and/or clinical via contact with i.e. referral source and/or patient/patient representative.
Communicate with doctors and facilities regarding questions on referrals and verification of insurance coverage.
Track expiring authorizations and obtain re-authorization for current patients.
Prompt return and follow up to all interactions; prompt response to internal and external inquiries and requests.
Communicate with doctors regarding new and ongoing patients authorized for service.
Sort and file paperwork (electronically or manually).
Maintain a working knowledge of all health information management requirements such as HIPAA
Maintain strict confidentiality.
Coordinate with other revenue cycle departments for follow up on billing matters and/or claim denials.
Communicate and collaborate with Director of Revenue Cycle to effectively resolve issues impacting the referral process.
Special projects as assigned
- High School Diploma or equivalent
- Some college preferred
-Minimum of 3-4 years in medical billing and referrals, insurance coverage and benefit verification, and insurance authorizations processes
-Medicare, Medicaid, HMO, PPO. Out of network and carve outs commercial insurances experience
-Prior experience with behavioral health services helpful but not required
-Experience in working with and committed to RCM Dept goals