Insurance Verif Auth Team

Under direct and indirect supervision of the Billing/Insurance Manager and/or Executive Director/Outpatient Imaging Administrator, accurately and efficiently verify patient insurance benefits and obtain necessary authorizations and referrals for services rendered at MRI & CT Diagnostics. Confirm deductibles, co-payments, cost-shares, and patient responsibility in a polite and professional manner.

Major Job Functions

Training and Leading New Employees, to Include:

• Phone etiquette

• Navigating the patient system

• Navigating websites for authorizations and benefits

• Training in how to obtain authorizations and benefits

• Calculating copays

• Daily operations

• Ensuring the employee is able to perform daily Insurance and Authorization job functions

• Reporting to the manager on the new employee’s progress

Secondary Job Functions

These responsibilities are to be completed as needed and alongside training responsibilities:

• Verify insurance coverage and benefits for all scheduled patients at least 24–48 hours in advance

• Confirm accurate billing address of carrier and contact person when appropriate

• Confirm patient demographics, referring physician information, and other chart information is accurate

• On behalf of the referring physician, obtain authorization for services from the insurance company if required

• Process patient and insurance carrier telephone calls

• Contact patient and/or referring physician when insurance coverage cannot be verified

• Notify patient of any co-payments, cost-shares, or deductibles

• Communicate with Scheduling Department when authorization cannot be obtained

• Communicate with the front desk regarding any special circumstances

• Properly notate accounts of all communications with patients

• Ensure that copies of all referrals, written authorizations, and authorization numbers are entered in the patient RIS record and provided to the billing department

• Obtain necessary clinical records to facilitate obtaining authorization

• Contact attorney, verify representation and billing address, date of accident or injury; instruct front desk personnel to obtain patient signature on lien letter

• Review authorization letters for accuracy

• Refer patients with special payment circumstances to management

• Communicate changes in insurance company requirements with staff and management

• Maintain the current exam board as well as the pending board

Qualifications

• High School Diploma

• Previous healthcare experience preferred; courses in medical terminology preferred

• Ability to operate copier, fax machine, and computer

• Must have excellent organizational, communication, and interpersonal skills

• Ability to set priorities and manage varying workload

Specifications

• Must be able to remain calm in stressful situations

• Must display courtesy and empathy toward coworkers and physicians

• Must be able to make sound judgments and execute appropriate actions based on knowledge of departmental policies and procedures

• Must be discreet with confidential information and abide by corporate HIPAA policies

• Must be able to move about freely; sits, stands, and walks intermittently during the day

• Must possess sufficient visual and auditory acuity, and manual dexterity to perform tasks

• Must attend mandatory practice training and departmental requirements annually

• Works in a clean, well-lit medical facility; subject to electrical, chemical, magnetic, and radiant energy hazards; exposure to infectious disease and lifting hazards; must stoop and bend in the course of job performance