Job Summary: 

• Ensure insurance verification is completed accurately and within a minimum of three days prior to the date of service.
• Data entry is accurate and completed in the patient accounting software (HST) according to procedure.
• Make sure authorization forms are in the medical record prior to the date of service.
• Contact patients to communicate patient responsibility due on the date of service.
• Verify a minimum of thirty-five accounts daily.
• Assure Health Stream education is up to date and completed prior to annual evaluation.
• Participate in regular departmental staff meetings and facility-wide meetings.
• Assist in the orientation of new staff and ensure a high level of employee satisfaction and retention.

Skills on Resume: 

• Insurance Verification (Hard Skills)
• Data Entry (Hard Skills)
• Authorization Management (Hard Skills)
• Patient Communication (Soft Skills)
• Account Verification (Hard Skills)
• Education Compliance (Hard Skills)
• Meeting Participation (Soft Skills)
• Staff Orientation (Soft Skills)

Job Summary: 

• Proactively identifies resources for patients.
• Communicate with families the financial resources available to patients whose health plan does not include coverage for services, coordinating counseling services with Financial Counseling.
• Collaborate with the Appeals department to overturn claims denied, as well as the Managed Care department in contract negotiations.
• Initiate and perform revenue cycle activities required for pre-registration.
• Work collaboratively with team members to provide quality service.
• Proactively support efforts that ensure delivery of safe patient care and services and promote a safe environment at Children's Healthcare of Atlanta.
• Interview patients and/or family members to secure information concerning insurance coverage, eligibility, and qualification for various financial programs.
• Coordinate and perform verification of insurance benefits by contacting the insurance provider and determining eligibility for coverage.
• Communicate the status of the verification/authorization process with appropriate team members in a timely and efficient manner.
• Provide clinical information, emphasizing medical justification for procedure/service to insurance companies for completion of the pre-certification process.

Skills on Resume:

• Patient Resource Identification (Soft Skills)
• Family Financial Communication (Soft Skills)
• Appeals Collaboration (Soft Skills)
• Pre-Registration (Hard Skills)
• Team Collaboration (Soft Skills)
• Insurance Interviewing (Hard Skills)
• Benefit Verification (Hard Skills)
• Pre-Certification (Hard Skills)

Job Summary: 

• Confirm that the referring physician has obtained prior authorization from the insurance company for all scheduled healthcare procedures within the assigned department/area.
• Contact referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial authorizations.
• Maintain tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
• Pre-screen doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment.
• Collaborate with the Appeals department to provide all related information to overturn claims denied.
• Monitor insurance authorization issues to identify trends and participate in process improvement initiatives.
• Respond to all inquiries from throughout the system and outside related to authorization/pre-certification issues.
• Provide ongoing communication to physician offices, patients/families, and others to resolve insurance authorization issues.
• Act as liaison between clinical staff, patients, referring physicians’ office, and insurance by informing patients and families of authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure/service.

Skills on Resume:

• Authorization Confirmation (Hard Skills)
• Procedure Rescheduling (Soft Skills)
• Eligibility Tracking (Hard Skills)
• Order Pre-Screening (Hard Skills)
• Appeals Collaboration (Soft Skills)
• Process Improvement (Soft Skills)
• Inquiry Response (Soft Skills)
• Authorization Liaison (Soft Skills)

Job Summary: 

• Promote a positive work environment and contribute to a dynamic, team-focused work unit that actively helps one another achieve optimal department results (EF).
• Contribute to patient, employee, and physician satisfaction.
• Proactively presents solutions to resolve access to care issues.
• Serve as a liaison between the patients, facility, physicians, and department.
• Ensure timely and accurate financial clearance of all accounts.
• Communicate with scheduling to inform the patient of authorization.
• Ensure accounts are financially secure by reviewing and documenting benefits, patient liabilities, authorization/pre-certification requirements, notification requirements, and other relevant information.
• Monitor and track authorizations, including ensuring accurate Current Procedural Terminology (CPT) codes, location of service performed and expiration dates.
• Communicate to resolve patient access and quality service matters.
• Respond promptly to requests and keep open channels of communication with the physician, patient, and service areas regarding financial clearance status and resolution.
• Maintain confidentiality in all communications.
• Timely and accurately obtains and records eligibility and benefit information, including limitations and exclusions, for all patients in the appropriate systems and screens/fields within the systems.

Skills on Resume:

• Positive Work Environment (Soft Skills)
• Satisfaction Contribution (Soft Skills)
• Access Solutions (Soft Skills)
• Patient Liaison (Soft Skills)
• Financial Clearance (Hard Skills)
• Authorization Communication (Soft Skills)
• Account Security Review (Hard Skills)
• Authorization Monitoring (Hard Skills)

Job Summary: 

• Refer to the Health Care System’s financial clearance policy as a guideline.
• Document the appropriate patient liability portion, co-pays, and/or deductibles, prior to, or on, the day of service.
• Complete high-quality work while adhering to productivity standards.
• Ensure documentation standards are followed and account notations are made in the appropriate systems in a timely and accurate manner.
• Notify the payer of the patient’s admission or procedure in a timely manner to ensure third-party reimbursement.
• Evaluate patient liability and generate estimates for patient financial responsibility communication.
• Organize time effectively, minimizing incidental overtime, and set priorities.
• Utilize time between heavy workloads efficiently and help other team members.
• Display initiative to improve job functions.
• Offer suggestions to streamline the process for efficient patient flow.
• Participate in various department and/or entity/system-wide projects and activities.
• Seek opportunities to expand learning beyond baseline competencies with a focus on continual development.

Skills on Resume:

• Policy Adherence (Hard Skills)
• Liability Documentation (Hard Skills)
• Productivity Compliance (Hard Skills)
• Accurate Documentation (Hard Skills)
• Payer Notification (Hard Skills)
• Financial Estimation (Hard Skills)
• Time Management (Soft Skills)
• Process Improvement (Soft Skills)

Job Summary: 

• Print the schedule for the day.
• Call insurance companies and to verify and complete all insurance information and benefits.
• Enter insurance information into the computer.
• Handle add-on surgeries in the same manner.
• Responsible for answering the phones.
• Check if authorization is required by portals or when calling insurance.
• Create a verification schedule of coverage for the month.
• Print daily schedule and confirm all referrals/authorizations have been obtained and the patient's monetary responsibility is recorded on the schedule.
• Shred all paperwork that displays private patient information.
• Translate to assist with patient calls with any collector.
• Work closely with collectors and the supervisors regarding previous account balances, high deductible and special billing circumstances.
• Attend in-services and feedback sessions for updates on insurance changes, policy modifications, and discussion of current verification issues and goals.
• Learn and understand the different practice management systems.
• Assist other departments with any copying, scanning, or other duties.

Skills on Resume:

• Schedule Printing (Hard Skills)
• Insurance Verification (Hard Skills)
• Data Entry (Hard Skills)
• Surgery Coordination (Hard Skills)
• Phone Handling (Soft Skills)
• Authorization Checking (Hard Skills)
• Coverage Scheduling (Hard Skills)
• Referral Confirmation (Hard Skills)

Job Summary: 

• Maintain, review and control daily in-house admissions documents.
• Obtain insurance eligibility, prior approval and prior authorization from Insurance carriers.
• Obtain patient signatures on all needed documents, such as Consent for Care or missing information as related to Medicare or Tricare, etc.
• Phone patients to obtain insurance and COB information, inform them of financial responsibility and discuss various payment options.
• Update, changes, or add demographic and billing information in the EPIC system.
• Contact all insurance carriers, per the patient's information.
• Ensure proper coordination and reimbursement of benefits.
• Break down managed care contract reimbursement and estimate patients' financial responsibilities.
• Work with physician offices to ensure proper authorization is obtained.

Skills on Resume:

• Admissions Documentation (Hard Skills)
• Insurance Authorization (Hard Skills)
• Patient Consent (Hard Skills)
• Patient Communication (Soft Skills)
• Demographic Updates (Hard Skills)
• Insurance Contact (Hard Skills)
• Benefit Coordination (Hard Skills)
• Reimbursement Estimation (Hard Skills)

Job Summary: 

• Verify insurance coverage of each patient.
• Handle payments for services not covered by insurance.
• Explain coverages to patients.
• Obtain referrals for patients when they are not covered.
• Update patient information/keep records.
• Fill out the documentation required for billing.
• Responsible for security authorization and precertification of inpatient and outpatient services.
• Responsible for the pre-registration and registration accuracy.
• Participate in departmental team-building activities and in-services.
• Responsible for the identification and evaluation of benefits and determining patients ' out-of-pocket expenses after insurance.

Skills on Resume:

• Insurance Verification (Hard Skills)
• Payment Handling (Hard Skills)
• Coverage Explanation (Soft Skills)
• Referral Management (Hard Skills)
• Record Updating (Hard Skills)
• Billing Documentation (Hard Skills)
• Authorization Management (Hard Skills)
• Registration Accuracy (Hard Skills)