Job Summary: 

• Obtain preregistration patient demographic information and insurance information.
• Create a medical record and input collected information into billing software in a complete and accurate manner.
• Perform verification of benefits and referral/authorization collection within the assigned region.
• Serve as an intermediary between patients and outside sources related to questions or problems that patients may have regarding their insurance benefits.
• Organize and transmit necessary documents to referring providers, validating and approving the plans of care constructed by the clinical team.
• Ensure the prompt return of initial and recertified signed Plans of Care from referring providers.
• Perform general business office work, including answering phones, retrieving voice mail, and returning calls to patients and providers.
• Organize, scan and/or save all paper and/or electronic documents received from outside sources into the EMR accurately.
• Review and update patient electronic records, ensuring the accuracy of information and identifying missing data.

Skills on Resume:

• Patient Data Collection (Hard Skills)
• Medical Record Entry (Hard Skills)
• Benefits Verification (Hard Skills)
• Patient Communication (Soft Skills)
• Document Management (Hard Skills)
• Plan Tracking (Soft Skills)
• Office Communication (Soft Skills)
• Record Updating (Hard Skills)

Job Summary: 

• Process pre-admission forms and initiate patient registration in a timely and efficient manner.
• Verify insurance eligibility and benefits with accurate identification of patient co-pays, deductibles, and out-of-pocket expenses.
• Obtain any required authorizations or pre-certifications prior to services being rendered.
• Identify problematic payers or limited benefits and work with physician offices to redirect services.
• Ensure medical necessity requirements are met for scheduled services.
• Contact patients regarding out-of-pocket expenses, claims processing, and hospital billing procedures.
• Deliver self-pay quotes.
• Cooperate with others to meet department requirements and goals.
• Perform other required duties in a timely, professional and efficient manner.

Skills on Resume:

• Patient Registration (Hard Skills)
• Insurance Verification (Hard Skills)
• Authorization Processing (Hard Skills)
• Payer Resolution (Soft Skills)
• Necessity Review (Hard Skills)
• Financial Communication (Soft Skills)
• Self-Pay Quoting (Hard Skills)
• Team Collaboration (Soft Skills)

Job Summary: 

• Understand medical insurance, including deductibles, copays and coinsurance.
• Work in a high-work-volume environment.
• Verify and interrupt medical benefits for Medicare, Medicaid and major commercial health insurance and secondary payers.
• Process provider referrals and prior authorization requests.
• Understand medical terminology and ICD-10 codes and diagnoses.
• Verify patient eligibility via payer websites or telephone to determine coverage of benefits and to calculate patient responsibility for services scheduled.
• Add or update patient insurance primary and/or secondary insurance in EHR.
• Familiar with individual payer guidelines and authorization/referral requirements based on insurance plans.
• Communicate with insurance companies via phone and/or website.
• Provide any supporting clinical documentation needed to complete the authorization process.
• Ensure complete and accurate information is maintained in the patient account, including authorization or referral received from the payer or Primary Care Physician.

Skills on Resume:

• Insurance Knowledge (Hard Skills)
• Benefits Verification (Hard Skills)
• Referral Processing (Hard Skills)
• Medical Terminology (Hard Skills)
• Eligibility Verification (Hard Skills)
• Insurance Data Entry (Hard Skills)
• Insurance Communication (Soft Skills)
• Account Accuracy (Hard Skills)

Job Summary: 

• Verify all patients' insurance who have upcoming appointments the following week.
• Review patient information and refer to insurance provider websites for plan benefits.
• Direct communications with members, providers and health plans.
• Confirm benefits and eligibility information to members, providers and health plans.
• Provide confirmation of participating providers in the network.
• Keep managers informed of any issues that may require their attention in order to avoid or resolve an existing problem.
• Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with.
• Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.).
• Responsible for redirecting callers.
• Follow up until completion on all issues that are not resolved on the initial contact, and keep parties updated on steps and actions taken.
• Service the maximum number of callers in the quickest and most efficient way without sacrificing the quality of the service.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Benefit Review (Hard Skills)
• Direct Communication (Soft Skills)
• Eligibility Confirmation (Hard Skills)
• Provider Network Check (Hard Skills)
• Issue Reporting (Soft Skills)
• Critical Thinking (Soft Skills)
• Customer Service (Soft Skills)

Job Summary: 

• Monitor daily schedules across all clinic locations.
• Ensure every patient has active insurance coverage or is set to self-pay.
• Notify the front office of the expected amount to collect from the patient for self-pay patients 
• Ensure the correct payer is set within the PM and ensure authorization is on file as needed by the plan.
• Work with clinical care teams to close authorization gaps prior to the patient visit/service date.
• Track all authorizations and report daily on gaps.
• Responsible payer based on line of service, office visit vs. behavioral health, etc.
• Responsible payer address, Financial Class accuracy, subscriber name, ID, group, and effective dates.
• Follow up on authorization gaps, ensuring they are closed the day prior to the patient visit and communicate with management in a timely manner to ensure patient flow is not impacted.
• Calculate and document patient portions for collection/advisement at the time of service.
• Document items at the patient chart and encounter level (authorizations).

Skills on Resume:

• Schedule Monitoring (Hard Skills)
• Insurance Verification (Hard Skills)
• Self-Pay Processing (Hard Skills)
• Payer Setup (Hard Skills)
• Authorization Coordination (Hard Skills)
• Authorization Tracking (Hard Skills)
• Communication With Teams (Soft Skills)
• Patient Portion Calculation (Hard Skills)

Job Summary: 

• Retrieve insurance breakdown information prior to patient appointments.
• Ensure accurate data entry into Open Dental of the insurance plan information.
• Review existing insurance plans in Open Dental.
• Combine and ensure the accuracy of existing dental plans.
• Update patient benefit information in the organization's insurance system and verify that existing information is accurate.
• Ensure the patient receives a correct estimate of insurance payments for the treatment being presented.
• Coordinate with the practice, the third-party vendor and the RCM team.
• Work with assigned practice teams to ensure an exceptional patient experience.

Skills on Resume:

• Insurance Breakdown (Hard Skills)
• Data Entry (Hard Skills)
• Plan Review (Hard Skills)
• Plan Accuracy (Hard Skills)
• Benefit Updating (Hard Skills)
• Estimate Preparation (Hard Skills)
• Team Coordination (Soft Skills)
• Patient Experience (Soft Skills)

Job Summary: 

• Contact insurance companies and/or medical review departments by phone, Internet, fax (face sheets), electronic interface and provide minimal necessary patient information.
• Verify coverage eligibility and obtain benefit information, deductible, co-pays, co-insurance, out-of-pocket maximums and accumulators, authorization requirements, referral requirements, days approved if inpatient, and correct billing address.
• Initiate and validate authorization, notification and ensure authorizations, pre-certifications and referrals are secured.
• Follow up on all pending authorizations until the account is secured.
• Note any specific limitations, authorizations, exclusions, pre-existing clauses, and/or waiting periods that may apply.
• Work with the physician and/or financial counselors to discuss the timing of treatment and/or payment arrangements.
• Review detailed clinical information of trauma admissions (motor vehicle accident, personal injury, and/or workers’ compensation) to determine accident-related liability.
• Follow the same verification procedure for each payor, since most payors require the authorization/pre-certification process even as second or third insurance coverage on a patient.
• Calculate Hospital Cost Estimates based on plan benefit accumulators and CPT codes for hospital services.
• Identify any cost discrepancies based on coding and/or Payor contract.

Skills on Resume:

• Insurance Communication (Soft Skills)
• Eligibility Verification (Hard Skills)
• Authorization Processing (Hard Skills)
• Authorization Follow-Up (Hard Skills)
• Limitation Review (Hard Skills)
• Treatment Coordination (Soft Skills)
• Clinical Information Review (Hard Skills)
• Cost Estimation (Hard Skills)

Job Summary: 

• Work with the Analyst and vendors to resolve issues.
• Re-verify eligibility and ensure authorization of days extended for large dollar in-house accounts.
• Provide education and customer service to providers and departments regarding authorization protocols and plan benefits.
• Communicate daily with Physicians’ offices, patients, Surgery Scheduling, Customer Service, Financial Counselors, Clinical Resource Counselor/Utilization Review, Managed Care offices, Managed Care onsite RNs, Insurance Companies, LH System Office of Managed Care Contracts and various other hospital departments such as Patient Access, Imaging and Rehab.
• Faxe daily admission and discharge reports to designated insurance companies.
• Refer non-insured or underinsured patients to the Financial Counselor to determine patient liability, Medicaid eligibility, or financial assistance.
• Accurately records data needed for proper billing and follow-up in appropriate system fields.
• Maintain knowledge of contracts, managed care plans, Medicare Advantage plans, Payor/Plan codes, insurance laws, insurance company changes and shares information.
• Maintain current knowledge of System policies and procedures, System updates and/or upgrades and health care information.
• Attend staff meetings and training classes.

Skills on Resume:

• Issue Resolution (Soft Skills)
• Eligibility Re-Verification (Hard Skills)
• Provider Education (Soft Skills)
• Cross-Department Communication (Soft Skills)
• Report Submission (Hard Skills)
• Financial Referral (Soft Skills)
• Data Recording (Hard Skills)
• Contract Knowledge (Hard Skills)

Job Summary: 

• Pre-verify patients receiving treatment for physician consultations and procedures.
• Use various documents to determine if TDDC accepts the patient’s insurance.
• Effectively communicate to patients their financial responsibility (co-pay, deductible expenses, etc.) based on their insurance coverage.
• Verify patient insurance by means of phone, fax, and web.
• Enter benefits data for patients accurately in EMR.
• Refer complex issues to the supervisor for review and or action.
• Provide quality service to patients.
• Work on insurance billing projects.

Skills on Resume:

• Pre-Verification (Hard Skills)
• Insurance Acceptance Check (Hard Skills)
• Financial Communication (Soft Skills)
• Insurance Verification (Hard Skills)
• Data Entry (Hard Skills)
• Issue Escalation (Soft Skills)
• Patient Service (Soft Skills)
• Billing Projects (Hard Skills)

Job Summary: 

• Verify all insurance information and obtain referrals and authorizations for all scheduled procedures.
• Contact Referring Physicians for clinical information.
• Monitor the schedule for add-on patients and obtain appropriate information.
• Notate updated information in the computer system.
• Inform management of any pending issues that might delay the ability to perform the scheduled procedure.
• Monitor schedule for discrepancies, duplicate procedures and insurance authorizations conflicts.
• Accurately completes all appropriate documentation required for billing purposes.
• Ensure confidentiality of all health information as required by Florida Statutes and HIPAA guidelines, ensuring compliance.
• Perform miscellaneous job-related duties.
• Follow basic safety precautions.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Authorization Management (Hard Skills)
• Physician Communication (Soft Skills)
• Schedule Monitoring (Hard Skills)
• Issue Reporting (Soft Skills)
• Billing Documentation (Hard Skills)
• Confidentiality Compliance (Hard Skills)
• Safety Practices (Soft Skills)

Job Summary: 

• Coordinate, obtain, and manage accurate patient demographics for registration and management of hospital systems.
• Maintain and update accurate insurance demographics to ensure a clean claim.
• Responsible for performing insurance verification.
• Obtain prior authorization from the insurance company in alignment with the scheduled procedure.
• Collaborate with Patient Financial Services to perform the appeals process for claims denied due to missing prior authorization.
• Clearly and effectively communicate with internal/external customers in a time-sensitive manner.
• Facilitate and/or provide excellent customer service.
• Request payment of financial responsibility from the patient/guarantor.
• Post and reconcile outpatient payment batches.

Skills on Resume:

• Patient Demographics Management (Hard Skills)
• Insurance Data Accuracy (Hard Skills)
• Insurance Verification (Hard Skills)
• Authorization Processing (Hard Skills)
• Claims Appeals Support (Hard Skills)
• Effective Communication (Soft Skills)
• Customer Service (Soft Skills)
• Payment Processing (Hard Skills)

Job Summary: 

• Verify all insurance benefits for home health services to determine if insurance coverage meets the standards of admission.
• Obtain appropriate authorizations and/or precertification from insurance payers.
• Monitor authorizations and/or precertification for continuation of service.
• Communicate to the branches via phone, email and/or fax with the appropriate insurance coverage.
• Review the weekly recertification list for upcoming authorizations.
• Set up patient insurance information along with authorization information in the system.
• Maintain the contract matrix.
• Maintain the payer master file in the system.
• Review insurance contracts to ensure claim formats are set up in the system accurately.

Skills on Resume:

• Benefit Verification (Hard Skills)
• Authorization Management (Hard Skills)
• Service Continuation Monitoring (Hard Skills)
• Branch Communication (Soft Skills)
• Recertification Review (Hard Skills)
• Insurance Data Entry (Hard Skills)
• Contract Management (Hard Skills)
• Payer File Maintenance (Hard Skills)

Job Summary: 

• Maintain patient demographic information and data collection systems.
• Verify insurance eligibility and benefits for commercial payers utilizing online websites and portals or by contacting the payer directly.
• Work in conjunction with all teams of RCM to ensure clean claims.
• Verify hospice or home health coverage of patients, including communication to the field staff regarding this status, as well as communicating with hospice companies.
• Collaborate across departments and build effective relationships with internal and external customers to meet deadlines.
• Exhibit a high level of attention to detail and monitoring of work.
• Daily email communication with clinical staff, order fulfilment and management.
• Submit daily performance metrics.
• Provide excellent customer service for both incoming and outgoing inquiries.
• Maintain sensitivity to organizational workflow systems outside the immediate department.
• Understand the impact and implications of decisions and requests affecting other divisions, teams and/or individuals within the company.
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance.
• Attend continuing education courses.
• Continuously work towards the Company’s goal and vision.

Skills on Resume:

• Patient Data Management (Hard Skills)
• Eligibility Verification (Hard Skills)
• Claims Coordination (Hard Skills)
• Coverage Communication (Soft Skills)
• Cross-Department Collaboration (Soft Skills)
• Attention To Detail (Soft Skills)
• Email Communication (Soft Skills)
• Customer Service (Soft Skills)

Job Summary: 

• Verify insurance eligibility for both medical and vision insurances for upcoming patient appointments by utilizing online websites or by contacting the carriers directly via telephone.
• Responsible for documenting patient information in the electronic system to communicate eligibility to clinic team members.
• Verify insurance eligibility for surgical procedures, including cataract, cross-linking, pterygium, etc.
• Review patient deductibles and/or copays, complete cost share estimates and enter the electronic system for various locations.
• Coordinate with the front end/call center regarding scheduling errors.
• Responsible for entering insurance referrals.
• Answer questions from patients, clerical staff and insurance companies.
• Maintain the strictest confidentiality.
• Adhere to all HIPAA guidelines/regulations.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Data Documentation (Hard Skills)
• Surgical Eligibility (Hard Skills)
• Cost Estimation (Hard Skills)
• Scheduling Coordination (Soft Skills)
• Referral Entry (Hard Skills)
• Patient Communication (Soft Skills)
• Confidentiality Compliance (Hard Skills)

Job Summary: 

• Assist in insurance verification processes.
• Provide oversight and leadership over Insurance Verification Specialists.
• Prepare and submit monthly reporting.
• Answer a variety of correspondence from patients and their representatives, insurance companies, attorneys and administrators of estates regarding billing, insurance and payments.
• Interview or telephone the concerned parties regarding delinquent accounts or unusual collection problems.
• Maintain liaison with clinic supervisory personnel to coordinate collection efforts and resolve problems.
• Assist in the preparation of reports and analyses for the month-end close.
• Participate in performance improvement activities that ensure important processes and activities are measured, assessed and improved systematically.
• Maintain all security passwords given to him/her.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Team Leadership (Soft Skills)
• Report Preparation (Hard Skills)
• Billing Communication (Soft Skills)
• Account Resolution (Soft Skills)
• Department Liaison (Soft Skills)
• Financial Reporting (Hard Skills)
• Process Improvement (Soft Skills)

Job Summary: 

• Maintain storage of all electronic data essential for functioning on the server.
• Keep staff and patient information within the HITECH HIPAA privacy laws.
• Handle stressful situations and interact with others.
• Must be present during working hours at the office for in-person meetings and have access to a computer without violating company policy.
• Comply with policies, procedures, compliance guidelines and Code of Conduct.
• Comply with internal controls, policies and procedures.
• Comply with BayMark policies and procedures, Compliance Policy and Code of Ethics.
• Conduct all business activities in a professional and ethical manner, adhering to medical necessity compliance and financial compliance.
• Regular attendance is to be maintained.

Skills on Resume:

• Data Management (Hard Skills)
• HIPAA Compliance (Hard Skills)
• Stress Management (Soft Skills)
• In-Person Collaboration (Soft Skills)
• Policy Adherence (Hard Skills)
• Internal Controls Compliance (Hard Skills)
• Ethical Conduct (Soft Skills)
• Attendance Reliability (Soft Skills)

Job Summary: 

• Interact with all levels of the organization in a positive and motivational fashion, supporting the Company’s mission.
• Perform and complete special projects for all BayMark regions and billing modalities.
• Review the schedule on a daily basis to determine if all new patients have their insurance matters in order (e.g., referrals, pre-certifications, etc) before starting their treatment.
• Verify insurance, coordination of benefits and prior authorizations.
• Consult with patients regarding their financial responsibility, current benefits and limitations on coverage for their plan product, and payment options.
• Prepare financial estimates and meet with patients one-on-one.
• Work directly with the insurance representative to confirm all claims are submitted successfully and that payments are being processed on time.
• Participate in the implementation of procedures to improve the quality of work being processed.
• Reconcile the financial aspect of Insurance Verification cycles after completion.

Skills on Resume:

• Organizational Interaction (Soft Skills)
• Project Management (Hard Skills)
• Schedule Review (Hard Skills)
• Insurance Verification (Hard Skills)
• Financial Consultation (Soft Skills)
• Estimate Preparation (Hard Skills)
• Claims Coordination (Hard Skills)
• Process Improvement (Soft Skills)

Job Summary: 

• Responsible for full census of all RCA inpatient facilities, and 100% capacity utilization of outpatient/MAT programs.
• Promptly receives and processes prospective patients' insurance benefits.
• Responsible for all phases of the verification of benefits process, from ascertaining viability to procuring the benefit.
• Use online and telephonic systems to verify prospective patients' benefits.
• Ensure benefit documentation is accurate in the Salesforce.com system and other related systems.
• Responsible for documentation and communication of benefits, including co-pays, deductibles, and all other out-of-pocket expenses.
• Work collaboratively with Contact Center staff, field sales team, facilities, and professionals in the community to support the desired outcome for patients.
• Adhere to all regulatory and compliance policies while exhibiting compassion, professionalism, and care for the client always.
• Adhere to quality assurance guidelines.

Skills on Resume:

• Census Management (Hard Skills)
• Benefit Processing (Hard Skills)
• Benefit Verification (Hard Skills)
• System Documentation (Hard Skills)
• Financial Communication (Soft Skills)
• Team Collaboration (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Quality Assurance (Hard Skills)

Job Summary: 

• Maintain confidentiality of all patients.
• Comply with Center policies, procedures, and employee handbook.
• Participate in orientation and staff development programs.
• Responsible for attending center meetings.
• Answer all phone calls clearly and courteously.
• Relay information in an accurate, concise and timely manner.
• Prepare monthly and quarterly required state and assigned QA reports.
• Keep job-related skills current through approved training programs.

Skills on Resume:

• Confidentiality Compliance (Hard Skills)
• Policy Adherence (Hard Skills)
• Staff Development (Soft Skills)
• Meeting Participation (Soft Skills)
• Phone Communication (Soft Skills)
• Information Relay (Soft Skills)
• Report Preparation (Hard Skills)
• Skill Development (Soft Skills)

Job Summary: 

• Responsible for all HRF insurance verifications.
• Responsible for the tracking of insurance verifications.
• Responsible for review of billing info sheets for completeness and accuracy, to include correct insurance and insurance verification forms.
• Responsible for tracking the billing info sheets, including follow-up calls.
• Ensure that the responsible party's signatures are completed and on file.
• Responsible for subsequent or delinquent follow-up billings and phone calls related to co-insurance and private pay claims.
• Responsible for the creation and maintenance of HRF resident files kept on site at the HHI main office.
• Responsible for reviewing HRF resident files to be sure that necessary information is accounted for, especially pertaining to insurance info.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Verification Tracking (Hard Skills)
• Billing Review (Hard Skills)
• Follow-Up Communication (Soft Skills)
• Signature Compliance (Hard Skills)
• Billing Follow-Up (Hard Skills)
• File Management (Hard Skills)
• Record Review (Hard Skills)

Job Summary: 

• Identify denied claims due to insurance coverage and obtain the necessary paperwork related to these claims.
• Compile the necessary information related to the denied claims and track the progress of these claims.
• Responsible for the accurate and timely preparation and submission of reports required by management.
• Responsible for the preparation of monthly billing documentation for Medicare, Medicaid, and insurance companies to ensure proper payment of funds.
• Responsible for accumulating and entering any necessary billing documentation into Carelink.
• Responsible for the follow-up with the therapists, rehab managers, or area managers concerning billing issues.
• Ensure the timely preparation of HRF insurance verifications.
• Responsible for communication with customers concerning billing, collection and reconciliation of invoices.

Skills on Resume:

• Denied Claims Management (Hard Skills)
• Claims Tracking (Hard Skills)
• Report Preparation (Hard Skills)
• Billing Documentation (Hard Skills)
• Data Entry (Hard Skills)
• Billing Follow-Up (Soft Skills)
• Insurance Verification (Hard Skills)
• Customer Communication (Soft Skills)

Job Summary: 

• Verify insurance eligibility for behavioral health insurances for upcoming appointments by utilizing online websites or by contacting the carriers directly.
• Review patient deductibles and/or copays and enter them into the billing system and spreadsheets provided to the front-end department at all locations.
• Assist front-end staff and call center staff in understanding carrier websites and verification of eligibility.
• Participate in the development of organizational procedures and the update of forms and manuals.
• Work in conjunction with the reception to ensure clean billing.
• Participate in educational activities and attend monthly staff meetings.
• Assist in the development and communication of SOP for key areas.
• Improve accuracy and understanding of processes.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Cost Entry (Hard Skills)
• Staff Support (Soft Skills)
• Procedure Development (Hard Skills)
• Billing Coordination (Hard Skills)
• Staff Participation (Soft Skills)
• SOP Development (Hard Skills)
• Process Improvement (Soft Skills)

Job Summary: 

• Responsible for obtaining and documenting insurance eligibility, coverage and benefits.
• Accurately completing patient demographics and insurance information.
• Coordinate with insurance carriers to confirm all required information is current.
• Maintain open communication with the clinical staff during the entire eligibility process and provide timely updates from insurance carriers.
• Communicate with clinical staff of any changes in insurance coverage and benefits.
• Act as a liaison between the practice and insurance companies, patients, and third-party representatives regarding insurance coverage and benefits.
• Assist in obtaining referrals.
• Assist patients or responsible parties with the coordination of benefit issues.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Data Accuracy (Hard Skills)
• Carrier Coordination (Hard Skills)
• Clinical Communication (Soft Skills)
• Coverage Updates (Soft Skills)
• Liaison Role (Soft Skills)
• Referral Assistance (Hard Skills)
• Benefit Coordination (Soft Skills)

Job Summary: 

• Confirm pre-authorization requirements and submit available medical documentation.
• Communicate the successful authorization number or denial in the IDX system 1 business day prior to the procedure.
• Contribute to the achievement of established department goals and objectives and adhere to department policies, procedures, quality standards and safety standards.
• Ensure compliance with hospital /facility policies and procedures and governmental/accreditation regulations.
• Initiate and receive phone calls from patients at least one day prior to scheduled appointments/procedures.
• Confirm patient insurance information if unable to verify utilizing IDX, insurance website/phone system, or clearinghouse websites.
• Interact with practice employees, physicians and others by obtaining and communicating essential data and assisting other team members.
• Coordinate efficient patient flow through the practice.
• Obtain and communicate essential data to insurance companies and/or patients.
• Ensure processes are effectively followed in an efficient working environment.
• Obtain and maintain the most current coding information for appropriate payors.
• Communicate any policy changes to PAVAU management and team.
• Participate in multidisciplinary quality and service improvement teams.
• Participate in meetings, serve on committees, and represent the department and hospital/facility in community outreach efforts.
• Update the coordination of benefits and communicate required information to the clinical office in the IDX system and update patient demographic forms.

Skills on Resume:

• Authorization Management (Hard Skills)
• System Documentation (Hard Skills)
• Policy Compliance (Hard Skills)
• Patient Communication (Soft Skills)
• Insurance Verification (Hard Skills)
• Team Collaboration (Soft Skills)
• Patient Flow Coordination (Soft Skills)
• Coding Knowledge (Hard Skills)

Job Summary: 

• Review billing policies and procedures and make recommendations to improve efficiencies.
• Review and confirm authorizations and documentation for use in billing.
• Follow up on unpaid claims and submit appeals for denied claims.
• Accurately post and record insurance and patient payments.
• Collaborate with the team on collections and aged Accounts receivable to assist with claim payments or other issues.
• Audit patient demographics, insurance and account information.
• Ensure accurate and clean claim submission to payers.
• Contact payers and patients for account follow-up and payments.
• Adhere to all areas of compliance (CMS regulations, HIPAA and PCI compliance).

Skills on Resume:

• Process Improvement (Soft Skills)
• Authorization Review (Hard Skills)
• Claims Management (Hard Skills)
• Payment Posting (Hard Skills)
• Collections Collaboration (Soft Skills)
• Account Auditing (Hard Skills)
• Claim Submission (Hard Skills)
• Account Follow-Up (Soft Skills)

Job Summary: 

• Handle all activities related to obtaining patient demographics from transferring/receiving facilities.
• Verify Insurance/Eligibility on all patients through the use of online portals and making phone calls.
• Contact the customer directly to obtain additional insurance information.
• Contact Clinical and Flight Crew to obtain additional insurance information.
• Work with patients on the coordination of benefits issues between primary and secondary insurance carriers.
• Update the patient account with corrected insurance information.
• Meet daily and monthly departmental production goals set forth by the Supervisor.
• Ensure that the company is achieving its financial goals.

Skills on Resume:

• Patient Demographics (Hard Skills)
• Eligibility Verification (Hard Skills)
• Customer Communication (Soft Skills)
• Clinical Coordination (Soft Skills)
• Benefit Coordination (Soft Skills)
• Account Updating (Hard Skills)
• Goal Achievement (Soft Skills)
• Financial Compliance (Hard Skills)

Job Summary: 

• Maintain knowledge of and reference materials of the following Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and a list of current accepted insurance plans.
• Review reports, identify denied claims, research and resolve issues.
• Review payment postings for accuracy and to ensure account balances are current.
• Ensure information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicaid, and third-party payer requirements/online eligibility systems.
• Gather information from clinical documentation needed for obtaining authorizations.
• Collaborate with DS on initial and concurrent authorizations for DIDs Testing.
• Understand the benefit structure of all types of 3rd party insurance.
• Run, review, and maintain daily schedules for assigned programs by updating and re-verifying insurances.
• Provide great customer service and work as a team player.
• Update MyAvatar upon reviewing the monthly eligibility report and notify the PFS Manager of any retro billing.
• Contact insurance carriers to obtain benefit coverage, policy limitations, authorization/notification, and pre-certifications for clients.
• Interact directly with healthcare providers and research issues on benefits coverage with pharmacy and programs to provide guidance to clients about benefits coverage.

Skills on Resume:

• Payer Knowledge (Hard Skills)
• Denied Claims Management (Hard Skills)
• Payment Review (Hard Skills)
• Eligibility Systems Use (Hard Skills)
• Authorization Support (Hard Skills)
• Insurance Structure Knowledge (Hard Skills)
• Schedule Management (Hard Skills)
• Customer Service (Soft Skills)

Job Summary: 

• Conduct insurance verification and authorization validation on scheduled patients.
• Ensure eligibility and that benefits are in order for accurate claim submission and payment.
• Contact the Payer directly via telephone, and/or access the payer website.
• Request pre-authorization for scheduled procedures, urgent procedures, and imaging.
• Accurately notate the account with actions taken for pre-certification.
• Coordinate Peer-to-Peer reviews with Providers for denied requests.
• Follow up on pending authorization requests in a timely manner.
• Communicate with the patient and/or office regarding the patient’s financial responsibility.
• Ensure the Front Office is able to collect money such as copayments, deductibles, and co-insurance for the procedures.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Eligibility Confirmation (Hard Skills)
• Authorization Requests (Hard Skills)
• Account Documentation (Hard Skills)
• Peer Review Coordination (Soft Skills)
• Authorization Follow-Up (Hard Skills)
• Financial Communication (Soft Skills)
• Front Office Support (Soft Skills)

Job Summary: 

• Ensure the accuracy of patient demographic and insurance information, updating.
• Collect, verify, and communicate necessary information with clients’ insurance carriers to obtain behavioral health benefits.
• Communicate with clients regarding their co-pays and deductibles, as well as provide EOB efficiently and in a timely manner.
• Work with clinic staff to ensure a concise and efficient communication flow regarding the client’s benefit.
• Obtain prior authorization for services as required by the insurance company.
• Verify eligibility and behavioral health benefits by phone and computer.
• Manage grant-funded slots.
• Enter insurance and benefit info in EHR and medical billing software.
• Adhere to HIPAA privacy and confidentiality regulations and guidelines.

Skills on Resume:

• Data Accuracy (Hard Skills)
• Benefit Verification (Hard Skills)
• Financial Communication (Soft Skills)
• Clinic Coordination (Soft Skills)
• Authorization Processing (Hard Skills)
• Eligibility Verification (Hard Skills)
• Grant Management (Hard Skills)
• Confidentiality Compliance (Hard Skills)

Job Summary: 

• Verify patient insurance coverage.
• Ensure necessary procedures are covered by benefits and obtain patient deductibles and co-pays.
• Assist surgery counselors with insurance benefits.
• Pre-verify the patient’s insurance before an appointment.
• Obtain all necessary insurance information prior to the visit.
• Counsel patients about co-pays and deductibles.
• Help arrange payments for services that are not covered by their insurance companies, discussing different financing options to fit their budgets.
• Responsible for backup billing calls.

Skills on Resume:

• Coverage Verification (Hard Skills)
• Benefit Confirmation (Hard Skills)
• Counselor Support (Soft Skills)
• Pre-Verification (Hard Skills)
• Information Collection (Hard Skills)
• Patient Counseling (Soft Skills)
• Payment Assistance (Soft Skills)
• Billing Support (Hard Skills)

Job Summary: 

• Provide intake services and setup for all new patients.
• Coordinate the patient's care with physician offices, nurses, pharmacists and patients.
• Perform insurance verification for both major medical and pharmacy benefits.
• Coordinate prescription deliveries and refills for patients.
• Work with home health nursing visits and maintenance of a patient census throughout the course of their therapy.
• Support other team members in the healthcare team.
• Ensure a continuous quality improvement customer service approach by proactively identifying areas of improvement and communicating those ideas to the healthcare team.
• Maintain current documentation related to the patient's drug therapy and pharmacy care plan.
• Flag issues that need to be addressed.
• Coordinate responses and resolutions to issues with appropriate internal and external parties.
• Actively participates in roundtable discussions with Pharmacists, Nursing Services and Pharmacy Care Coordinators.
• Review cases and related drug therapy and pharmacy care plan issues.
• Maintain and promote positive and professional working relationships with associates and management.

Skills on Resume:

• Patient Intake (Hard Skills)
• Care Coordination (Soft Skills)
• Insurance Verification (Hard Skills)
• Prescription Coordination (Hard Skills)
• Census Management (Hard Skills)
• Team Support (Soft Skills)
• Quality Improvement (Soft Skills)
• Documentation Management (Hard Skills)

Job Summary: 

• Perform insurance prescreening and verification of benefits for multiple insurance providers.
• Communicate directly with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients, and families to ensure understanding of approved benefit levels.
• Maintain customer relationships and ensure business objectives are met.
• Review patient deductibles and/or copays and enter them into the billing system and maintain spreadsheets of data for reporting purposes.
• Coordinate with the site locations’ administrative support staff regarding scheduling errors.
• Assist the site in understanding carrier websites and verification of eligibility.
• Work in conjunction with the central billing department to ensure clean claim submission.
• Determine serviceability and make recommendations based on the patient’s insurance coverage.
• Identify the need for and obtain authorizations for service, calculate billable units for authorizations, understand the drug formularies, different therapies, and the associated diagnoses with each and examination of referrals for adherence to the required/qualifying insurance regulations.

Skills on Resume:

• Insurance Prescreening (Hard Skills)
• Benefit Communication (Soft Skills)
• Customer Relationship (Soft Skills)
• Cost Entry (Hard Skills)
• Scheduling Coordination (Soft Skills)
• Eligibility Support (Soft Skills)
• Claim Submission (Hard Skills)
• Authorization Management (Hard Skills)

Job Summary: 

• Verify referred patient insurance eligibility by utilizing various software tools, i.e, Medicare GHA, My Ability, Availity, Medicaid, etc, and capture all potential insurance coverages for the referred patient.
• Communicate eligibility results to the Intake department.
• Screen insurance information to identify patients requiring preadmission approval from third-party payors, verifying that approval has been obtained.
• Communicate/collaborate with patients' accounts, utilization review, intake, and any/all other needed departments/agencies/payers.
• Ensure the appropriate and timely handling of patient claims.
• Respond to requests from insurance carriers and medical personnel in a timely manner.
• Work independently in completing assigned tasks.
• Maintain a professional approach with confidentiality.
• Assure protection and privacy of health information as attained through written, electronic, or oral disclosures.
• Display concern and initiative.
• Seek guidance and remain knowledgeable of, and comply with, all applicable federal and state laws, as well as hospital polices that apply to assigned duties.
• Comply with hospital expectations regarding ethical behavior and standards of conduct.
• Comply with federal and hospital requirements in the areas of protected health information and patient privacy.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Intake Communication (Soft Skills)
• Preadmission Approval (Hard Skills)
• Cross-Department Collaboration (Soft Skills)
• Claims Handling (Hard Skills)
• Carrier Response (Soft Skills)
• Independent Work (Soft Skills)
• Confidentiality Compliance (Hard Skills)

Job Summary: 

• Contact insurance companies to verify eligibility and benefits.
• Complete insurance verification and reimbursement forms.
• Ensure all patient information is properly recorded in the EMR system.
• Meet performance goals and accomplish tasks in a timely manner.
• Communicate with clients and management in an effective and timely manner.
• Research, re-verify and resolve issues.
• Deliver the most remarkable patient experience in every dimension, every time.
• Foster team work, team member engagement and community involvement.
• Leverage diversity and inclusion in support of quality care.
• Responsible for fostering a safe patient environment driven by the principles of  First Do No Harm.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Form Completion (Hard Skills)
• Data Recording (Hard Skills)
• Goal Achievement (Soft Skills)
• Effective Communication (Soft Skills)
• Issue Resolution (Hard Skills)
• Patient Experience (Soft Skills)
• Teamwork (Soft Skills)

Job Summary: 

• Check insurance eligibility benefits and authorizations.
• Explain hospital policy, patient financial responsibilities, and patient rights.
• Efficiently and effectively navigate payer websites.
• Act as a resource for intake staff regarding enrollment and benefit concerns and issues.
• Protect each patient/participant’s confidentiality within the guidelines of established policy and process.
• Adhere to established policy and process for this assignment.
• Responsible for verifying a potential client's insurance benefits and providing an estimated insurance contribution (EIC) to admissions teams and the call center.
• Responsible for setting up client accounts and transferring insurance benefits into billing databases.
• Work effectively with the facility leadership team to ensure the success of the facility by completing the following.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Policy Explanation (Soft Skills)
• Website Navigation (Hard Skills)
• Staff Support (Soft Skills)
• Confidentiality Compliance (Hard Skills)
• Benefit Estimation (Hard Skills)
• Account Setup (Hard Skills)
• Team Collaboration (Soft Skills)

Job Summary: 

• Responsible for verifying patient insurance coverage.
• Ensure therapy treatment is covered for new patients 48 hours prior to the appointment.
• Assist the front office with add-ons.
• Understand and articulate information to the treating provider.
• Enter data such as insurance information into the patient account.
• Sit for long periods of time.
• Protect PHI and follow HIPAA regulations.
• Call Insurance companies and use electronic tools to verify patient insurance and benefits.
• Update patient charts to reflect this information.
• Re-verify all insurance coverage at the beginning of each year or when a patient has an insurance change.

Skills on Resume:

• Coverage Verification (Hard Skills)
• Treatment Confirmation (Hard Skills)
• Front Office Support (Soft Skills)
• Provider Communication (Soft Skills)
• Data Entry (Hard Skills)
• HIPAA Compliance (Hard Skills)
• Insurance Communication (Soft Skills)
• Record Updating (Hard Skills)

Job Summary: 

• Research required information using available resources.
• Identify, escalating priority issues and reporting to the high-level management.
• Route inbound calls to the appropriate clinics/personnel.
• Follow up on complicated customer calls.
• Complete call notes and call reports.
• Obtain and evaluate all relevant data.
• Manage administration, communicating and coordinating with internal departments.
• Responsible for initiating contact with insurance companies for verification and authorization of benefits information.
• Ensure timely and accurate insurance authorization.
• Interact with different team members and provide effective and responsive communication.
• Update and verify all patient information.

Skills on Resume:

• Information Research (Hard Skills)
• Issue Escalation (Soft Skills)
• Call Routing (Hard Skills)
• Customer Follow-Up (Soft Skills)
• Data Evaluation (Hard Skills)
• Administrative Coordination (Soft Skills)
• Authorization Management (Hard Skills)
• Team Communication (Soft Skills)

Job Summary: 

• Verify insurance coverage, in-network status, insurance benefits, and copay amount for primary, secondary, and tertiary insurance plans.
• Enter insurance benefits, demographics and prior authorization information into the patient’s profile.
• Obtain authorizations for different medical services from insurance.
• Maintain the electronic fax system, continuously reconciling and forwarding information to other departments.
• Navigate insurance companies’ websites to determine eligibility and benefits.
• Refer uninsured accounts to the Revenue Management Cycle Director and rendering provider.
• Contact the insurance carriers to verify insurance eligibility, benefits, and requirements as defined by the plan.
• Accurately utilizing the CRM to communicate benefit information.
• Create data entry into specified reports.
• Open and constant communication with the admissions, billing and UR departments, along with notifying management of potential insurance trends and/or policy changes.

Skills on Resume:

• Coverage Verification (Hard Skills)
• Data Entry (Hard Skills)
• Authorization Processing (Hard Skills)
• Fax Management (Hard Skills)
• Eligibility Navigation (Hard Skills)
• Uninsured Referral (Soft Skills)
• Carrier Communication (Soft Skills)
• Department Collaboration (Soft Skills)

Job Summary: 

• Verify eligibility and benefits using the electronic database/clearinghouse and via telephone.
• Use of online insurance portals for benefit verification.
• Responsible for interpreting medical benefits.
• Provide written insurance verification reports to medical provider offices and the supervisor.
• Initiate and perform prior authorization for skin substitutes.
• Monitor incoming faxes and emails for insurance verification requests.
• Maintain and update patient files in the database.
• Research and obtain information regarding patients' insurance coverage and benefits in order to help facilitate patients' treatment.
• Handle benefits request investigations submitted by MD (medical doctors) offices.
• Contact insurance companies to obtain information on a patient's medical benefits.
• Obtain each case's medical benefits for the procedure/diagnosis codes for the requested or prescribed medication or treatment.
• Interact with MD offices, other representatives, provide excellent customer service, and document case notes.

Skills on Resume:

• Eligibility Verification (Hard Skills)
• Benefit Interpretation (Hard Skills)
• Verification Reporting (Hard Skills)
• Authorization Processing (Hard Skills)
• Fax and Email Monitoring (Hard Skills)
• Patient File Management (Hard Skills)
• Coverage Research (Hard Skills)
• Customer Service (Soft Skills)

Job Summary: 

• Gather and verify all appropriate patient demographics, injury information and financial information, including Insurance benefits, eligibility, co-pays, deductibles and financial programs.
• Review registration critical checks, including MSPQ completion and presumptive eligibility.
• Establish payment sources through an online verification system, insurance website, or phone call to insurance companies.
• Determine appropriate insurance plan, financial class and insurance guarantors required for billing.
• Review photo ID, insurance cards and authorize for an accurate guarantor and demographic input into the Practice Management System.
• Review account authorization requirements and notify the insurance carrier in accordance with the patient benefit requirements.
• Respond promptly and accurately to telephone, written, and electronic inquiries from patients, providers, and in-house departments.
• Responsible for the identification and proper data entry of insurance details.
• Responsible for notifying the patient of any significant gaps in coverage and/or high co-pays or deductibles prior to services being rendered.
• Document authorizations or denied authorizations in appropriate systems as per protocol.
• Maintain a deep understanding of all major insurance plans and products.

Skills on Resume:

• Demographics Verification (Hard Skills)
• Eligibility Review (Hard Skills)
• Payment Source Verification (Hard Skills)
• Plan Determination (Hard Skills)
• Guarantor Input (Hard Skills)
• Authorization Management (Hard Skills)
• Inquiry Response (Soft Skills)
• Coverage Communication (Soft Skills)