Job Summary: 

• Verify policy and group number, as well as guarantor and dependents information, with the insurance company.
• Verify eligibility and benefits with the insurance company.
• Verify the claim mailing address of the insurance company.
• Annotate all scheduling changes appropriately in the patient’s history notes.
• Verify whether pre-certification or pre-authorization is required for the exam to be performed and reimbursed.
• Contact the referring physician's office to obtain additional information regarding the exam.
• Send to the insurance company for authorization of the exam.
• Notify the referring physician's office, the patient and/or the imaging center if the exam is not authorized or if the exam will not be covered.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Eligibility Check (Hard Skills)
• Claims Knowledge (Hard Skills)
• Record Documentation (Hard Skills)
• Authorization Review (Hard Skills)
• Physician Communication (Soft Skills)
• Authorization Submission (Hard Skills)
• Stakeholder Notification (Soft Skills)

Job Summary: 

• Ensure accurate and timely data entry into the RIS system for each patient, according to established standards.
• Utilize telephone voice response systems and website solutions to obtain information on patients' eligibility status with insurance companies.
• Work with patients to obtain complete and correct insurance information, discuss eligibility results and alternative payment methods.
• Properly analyzes various payor eligibility responses to find the information needed to complete verifications.
• Obtain and confirm insurance pre-authorizations.
• Follow all HIPAA, compliance, privacy and confidentiality standards.
• Maintain patient confidentiality at all times.
• Communicate with vendors, patients, referring physicians, co-workers and all team members in a courteous and professional manner.
• Maintain an insurance verification log of accounts/procedures verified.
• Contact insurance providers via email or phone to review the status of authorizations.

Skills on Resume:

• Data Entry Accuracy (Hard Skills)
• Eligibility Verification (Hard Skills)
• Insurance Information Collection (Soft Skills)
• Pre-Authorization Processing (Hard Skills)
• Confidentiality Compliance (Hard Skills)
• Professional Communication (Soft Skills)
• Authorization Follow-Up (Hard Skills)
• Eligibility Analysis (Hard Skills)

Job Summary: 

• Work with insurance companies and have extensive knowledge of different types of coverage and policies.
• Answer the telephone promptly and in a polite and professional manner.
• Answer questions and offer other information.
• Provide patient-focused service and a positive impression of the organization.
• Seek and support changes in call flow processes and communication services.
• Suggest improvements and participate in organized efforts to improve service levels.
• Adhere to all Sequence Health policies.
• Contact insurance companies and the patient regarding insurance.

Skills on Resume:

• Insurance Knowledge (Hard Skills)
• Professional Phone Etiquette (Soft Skills)
• Information Support (Soft Skills)
• Patient Service (Soft Skills)
• Process Improvement (Soft Skills)
• Service Enhancement (Soft Skills)
• Policy Compliance (Hard Skills)
• Insurance Communication (Hard Skills)

Job Summary: 

• Contact insurance companies and the patient regarding insurance benefits and coverage.
• Obtain and enter accurate demographic information into LeadTracker (address, telephone number, name of insurance as required by practice).
• Schedule a seminar or appointment correctly in LeadTracker or other scheduling system used by the customer-review seminar/appointment date, time, location, and provider name with the caller.
• Inform the caller of items to bring to the appointment (including insurance card and identification as required by practice).
• Remind the caller to arrive 15 to 30 minutes before the scheduled seminar/appointment to complete paperwork.
• Remind the caller of the cancellation/no-show policy.
• Answer questions and offer other information to provide patient-focused service.
• Meet and exceed call volume standards.

Skills on Resume:

• Insurance Contact (Hard Skills)
• Demographic Entry (Hard Skills)
• Appointment Scheduling (Hard Skills)
• Patient Instructions (Soft Skills)
• Arrival Reminder (Soft Skills)
• Policy Reminder (Soft Skills)
• Patient Support (Soft Skills)
• Call Volume Management (Hard Skills)

Job Summary: 

• Adhere to all HIPAA policies.
• Act as a liaison for the patients and the Health Center.
• Direct calls to other departments.
• Serve as a valuable resource to patients, providing pertinent information regarding their coverage.
• Use sound judgment in handling calls, especially with upset patients.
• Understand when to escalate calls to physicians/practice managers/triage nurses.
• Communicate with the practice via email and written communication regarding coverage.
• Provide assistance with call-backs and other projects as call volume permits.

Skills on Resume:

• HIPAA Compliance (Hard Skills)
• Patient Liaison (Soft Skills)
• Call Routing (Hard Skills)
• Coverage Guidance (Soft Skills)
• Call Handling Judgment (Soft Skills)
• Escalation Awareness (Soft Skills)
• Coverage Communication (Hard Skills)
• Call Support (Soft Skills)

Job Summary: 

• Enter authorization information into the Hospital Account in EPIC.
• Follow up on patient and Physician office concerns or questions.
• Incorporate new policies and procedures into daily responsibilities and ask supervisor questions for clarification.
• Maintain knowledge of third-party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker's Compensation, Auto Insurance and Managed Care contracts) and insurance compliance.
• Make recommendations for improving department systems, policies and procedures.
• Create hospital account records for all surgical cases.
• Account completed in a timely manner to improve customer satisfaction and allow for referral and authorization prior to patient's arrival.
• Educate referring Physician offices on authorization/referral requirements for surgical procedures.
• Perform all other duties deemed necessary in the department's mission to serve patients.
• Review all inpatient and Short procedure surgery accounts for completion of registration and insurance data.
• Revise registration with correct insurance, demographics and guarantor information.
• Resolve complex insurance verification questions.
• Maintain working knowledge of insurance plans participating with UPMC Pinnacle.
• Act as a liaison regarding billing questions, as well as any changes staff need to make to a patient's account to ensure acceptance of a claim.

Skills on Resume:

• Authorization Entry (Hard Skills)
• Patient Support (Soft Skills)
• Policy Adaptation (Soft Skills)
• Insurance Knowledge (Hard Skills)
• Process Improvement (Soft Skills)
• Account Creation (Hard Skills)
• Timely Completion (Hard Skills)
• Verification Resolution (Hard Skills)

Job Summary: 

• Consistently demonstrates professional and customer service-focused behavior at all times, including manner of communication, responsibility and appearance.
• Call the insurance company or verify online.
• Obtain eligibility and benefit information for all inpatients admitted on days prior to the last business working day, all outpatient surgeries and all future pre-admissions and outpatient tests/procedures.
• Check daily admission reports, and/or surgical procedures, and outpatient schedules to ensure all patients are accounted for.
• Call or obtain online any required referrals, pre-authorizations, or pre-certifications, RQI, or tracking numbers for applicable accounts to assure reimbursement and minimize denials.
• Enter complete and accurate notes in HWS regarding benefits, pre-authorizations, UR review requirements, patient payment arrangements and other pertinent information in a timely manner.
• Review and update incorrect patient, guarantor, or insurance information entered in the Meditech Admissions module.
• Use existing tools/resources in order to minimize denial of claim/lost revenue.
• Call patients with group or private health insurance that has a deductible, co-pay, or co-insurance.

Skills on Resume:

• Professional Conduct (Soft Skills)
• Insurance Verification (Hard Skills)
• Eligibility Check (Hard Skills)
• Schedule Monitoring (Hard Skills)
• Authorization Retrieval (Hard Skills)
• Accurate Documentation (Hard Skills)
• Data Correction (Hard Skills)
• Patient Financial Contact (Soft Skills)

Job Summary: 

• Meet, explain benefits and payment options and make appropriate deposit and initial payment arrangements or provide information about a financial assistance program.
• Refer to the Financial Counselor any patient who expresses reluctance, difficulty, or concerns with regard to the timely payment of existing financial liabilities.
• Refer to the Financial Counselor any patient whose benefits are inadequate, terminated, or whose benefits cannot be verified after checking for further or new information with the patient, the patient’s employer, or any other available resource.
• Follow up with insured patients involving third-party liability (WC, personal injury, auto accident, etc.).
• Ensure appropriate forms are completed, signed and scanned into HWS.
• Notify appropriate individuals (Case Manager and/or Mgr, Physician, etc) whenever a Medicare inpatient has 5 or fewer available benefit days and/or the patient’s insurance is terminated.
• Obtain consent to use Lifetime Reserve Days for Medicare patients who have exhausted available renewable benefit days.
• Notify the director regarding admission and registration quality.
• Assist in identifying potential performance issues and training and educational opportunities.

Skills on Resume:

• Payment Arrangement (Soft Skills)
• Financial Referral (Soft Skills)
• Insurance Escalation (Hard Skills)
• Third-Party Follow-Up (Hard Skills)
• Form Completion (Hard Skills)
• Benefit Notification (Hard Skills)
• Medicare Consent (Hard Skills)
• Quality Reporting (Soft Skills)

Job Summary: 

• Verify customer benefits via phone, fax, and/or web portal.
• Assure members’ insurance policies (past and present) are accurately reflected in the AS400.
• Update the tracking system with accurate and relevant information.
• Demonstrate knowledge of insurance plan guidelines and the use of electronic systems for verification purposes.
• Use electronic systems and payer websites for verification of insurance, authorizations, and referrals.
• Review and approve documentation received by third parties for submission to payers for reimbursement of orders shipped.
• Answer questions from customers, clerical staff, insurance companies, and physician offices.
• Identify and resolve patient complaints.
• Explain and collect co-pays, deductibles and other patient balances.
• Make patients fully aware of financial obligations and eligibility for programs that may provide financial aid.
• Provide patient education regarding third-party coverage and liabilities.

Skills on Resume:

• Benefits Verification (Hard Skills)
• Policy Accuracy (Hard Skills)
• System Updates (Hard Skills)
• Insurance Guidelines Knowledge (Hard Skills)
• Electronic Verification (Hard Skills)
• Reimbursement Review (Hard Skills)
• Customer Support (Soft Skills)
• Financial Counseling (Soft Skills)

Job Summary: 

• Verify that all demographic and insurance information is present in the chart.
• Confirm the accuracy of both insurance and patient information that is in the billing system.
• Use workflow to input information into the system.
• Confirm that the time management and admission information are accurate in the billing system.
• Identify any changes made to client information.
• Identify any changes made by payors in each state.
• Keep management informed of any problems viewing scanned charts.
• Obtain clarification of policy and may use the resources available through the Compliance, Human Resources, or Legal Department to do so.
• Support and abide by the values of the company.
• Read and abide by the company’s code of conduct, ethics statements, employee handbooks, policies and procedures and other corporate mandates, including participation in mandatory training programs.
• Report any real or suspected violation of the corporate compliance program, company policies and procedures, harassment, or other prohibited activities in accordance with the reporting policies of the company.

Skills on Resume: 

• Information Verification (Hard Skills)
• Billing Accuracy (Hard Skills)
• Workflow Entry (Hard Skills)
• Time Data Validation (Hard Skills)
• Client Info Updates (Hard Skills)
• Payor Change Tracking (Hard Skills)
• Compliance Support (Soft Skills)
• Policy Adherence (Soft Skills)

Job Summary: 

• Conduct the Insurance verification process within 24 hours of receipt of the reservation/notification for both inpatient and outpatient services.
• Follow the scripted benefits verification format in the appropriate systems' custom benefits screen and record benefits.
• Contact the physician to resolve issues regarding prior authorization or referral forms.
• Perform electronic eligibility confirmation and document results.
• Research Patient Visit History to ensure compliance with the Medicare 72-hour rule.
• Complete the Medicare Secondary Payor Questionnaire for retention in the Abstracting module.
• Perform insurance verification and account status changes at the assigned facility.
• Communicate with hospital-based Case Manager to ensure prompt resolution of pre-existing, non-covered, and re-certification issues.
• Utilize system account notes and Collections System account notes.
• Cut and paste the benefit and pre-authorization information and to document key information.
• Perform Insurance Verification activities based on production quotas.

Skills on Resume:

• Timely Verification (Hard Skills)
• Benefits Documentation (Hard Skills)
• Authorization Resolution (Soft Skills)
• Eligibility Confirmation (Hard Skills)
• Medicare Compliance (Hard Skills)
• Insurance Updates (Hard Skills)
• Case Manager Coordination (Soft Skills)
• Quota-Based Processing (Hard Skills)

Job Summary: 

• Communicate information in a clear, well-organized, and professional manner.
• Analyze data on a problem-to-problem solution.
• Seek opportunities to learn and grow.
• Quickly and accurately perform data entry.
• Follow established guidelines to focus on details and complete tasks attentively and thoroughly.
• Manage one’s own time to perform job functions quickly and efficiently.
• Adapt and be flexible in a complex, changing environment.
• Represent the organization to customers and other external sources by phone or e-mail.
• Build constructive and cooperative working relationships.
• Motivational, inspirational and enthusiastic approach to team involvement and engagement.
• Manage confidential information with sensitivity and maturity.
• Escalate issues when necessary.
• Utilize established procedures to guide decision-making.
• Provide personalized and quality service to meet the expectations of internal and external customers.
• Work independently with little supervision or direction.

Skills on Resume:

• Clear Communication (Soft Skills)
• Problem Solving (Soft Skills)
• Continuous Learning (Soft Skills)
• Accurate Data Entry (Hard Skills)
• Detail Orientation (Hard Skills)
• Time Management (Soft Skills)
• Adaptability (Soft Skills)
• Relationship Building (Soft Skills)

Job Summary: 

• Directly Calling Insurance Companies to obtain Insurance Benefits.
• Handle financial obligations prior to procedures.
• Coordinate self-pay referrals to the eligibility service.
• Appropriately documenting and reporting payment information.
• Communicate with patients regarding insurance benefits, payment plans and expectations.
• Work with Upper Management and Administration Staff for approvals.
• Work with multiple programs at one time.
• Contact physicians, insurance companies, and/or necessary departments to obtain authorizations or referrals.

Skills on Resume:

• Insurance Calling (Hard Skills)
• Financial Handling (Hard Skills)
• Self-Pay Coordination (Hard Skills)
• Payment Documentation (Hard Skills)
• Patient Communication (Soft Skills)
• Approval Coordination (Soft Skills)
• Multisystem Use (Hard Skills)
• Authorization Retrieval (Hard Skills)

Job Summary: 

• Answer phones and guide patients through this sometimes difficult process by kindly talking them through the steps and answering their questions and concerns.
• Responsible for verifying insurance eligibility.
• Responsible for obtaining authorizations.
• Cross-train and help in other departments.
• Participate in various projects and/or meetings, and complete other tasks as assigned by management.
• Verify all Commercial, Private, and Government Insurance.
• Call Insurance companies and obtain verification through the payor web portals.
• Responsible for reviewing insurance contracts.

Skills on Resume:

• Patient Guidance (Soft Skills)
• Eligibility Verification (Hard Skills)
• Authorization Handling (Hard Skills)
• Cross-Department Support (Soft Skills)
• Project Participation (Soft Skills)
• Insurance Verification (Hard Skills)
• Payer Communication (Hard Skills)
• Contract Review (Hard Skills)

Job Summary: 

• Work from the hospital's electronic health record to obtain insurance verification completeness.
• Obtain insurance authorization, working closely with Case Management.
• Determine the patient's out-of-pocket amount with accuracy, and the utilization benefit level obtained.
• Minimize and avoid denials of claim reimbursement due to lack of authorization.
• Scan documentation into the electronic health record.
• Assist with the completeness of correspondence received by the hospital, pertaining to the insurance verification and authorization process.
• Communicate with physicians’ offices, their staff, and the patient, as to out-of-pocket amounts and benefit structure.
• Verify, update, and enter patient insurance information into the company database.

Skills on Resume:

• EHR Verification (Hard Skills)
• Authorization Coordination (Hard Skills)
• Out-of-Pocket Calculation (Hard Skills)
• Denial Prevention (Hard Skills)
• Document Scanning (Hard Skills)
• Correspondence Support (Hard Skills)
• Benefit Communication (Soft Skills)
• Insurance Data Entry (Hard Skills)