Reviews and validates insurance eligibility, prior authorization and/or referral of medication, testing, procedures, and surgery is completed and confirmed. Contacts third party payer to determine appropriate prior authorization process. Reviews professional services denials; works with clinics and third party payers on appeal process. Collaborates with care teams, case management, and other cross-functional teams. Assists patients with insurance related questions and problems, corrects insurance computer screens, assists patients in filing insurance claims and completing insurance forms, works with insurance companies to pre-certify patients for surgery, answers patient correspondence, and performs related duties.
Pre-Certification Duties: 75% of the Work Period
Assists Patients with Insurance
Billing and Coding Questions: 10% of the Work Period
Resolves Problems with Insurance 10% of the Work Period
Corrects Insurance Screens: 5% of the Work Period
PRIMARY RESPONSIBILITIES AND DUTIES:
1. Assists patients with insurance related questions and problems such as balances and questions on charges, corrects insurance
computer screens, and assists patients in filing insurance claims and completing insurance forms
2. Counsels patients regarding financial responsibilities, aids in making a workable payment arrangement.
3. Processes Medicare and Welfare account transfers, denials, missing numbers, supplement claims and bulletins
4. Responsible for assuring that prior authorization for medical services, including testing, procedures, surgery, and medications is
completed and confirmed. Contacts third party payer to determine appropriate prior authorization process
5. Reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc. Reviews professional
services denials; works with clinics and third party payers on appeal process.
6. Sends statements to counties for payment, and sends itemized statements to patients upon request.
7. Registers patients, sets up new patient accounts, checks insurance card against patient coverage on computer screen, updates
information; verifies patient address and phone number and ensures completion of all areas on patient information screens,
photocopies insurance cards, determines method of payment for appointments, collects co-payments, payment arrangement
payments and writes receipts. Verifies necessity for referral and assists in obtaining referral or pre-certification information.
8. Performs related duties to include directing patients to appropriate physician wing, answering switchboard calls, and directing calls
to appropriate location. Performs related duties to include answer patient correspondence, and sorting mail for the department.
**Essential functions per ADA Guidelines**
♦ High School diploma or GED.
♦ Basic computer, office machine, and eCW system knowledge, typing and keypunching skills, effective oral communication, and
telephone etiquette are required. 10 Key-by-Touch skills familiarity with insurance methods, and medical terminology are preferred.
♦ Minimum of six months of Insurance experience is required.
♦ Respect for and ability to follow Clinic’s Confidentiality Policy.
APPLY NOW - To apply for a position(s), complete one of the following options: Online Application, PDF Application or Word.DOC Application. For more information on becoming a member of the Brown Clinic team, contact Human Resources at 605-884-4247 or click here.