- Collects and enters accurate demographic, guarantor and financial data for Emergency Department
- Verifies all required insurance and billing information and uses the proper payer plan codes.
- Generates all necessary forms for patient visit and obtains patient/parent/legal guardian signature for Assignment/ Authorization and consent.
- Performs pre-registration for scheduled patients and registers patients upon arrival adhering to standard department procedure.
- Schedule complex appointments
- Answer telephone and triage calls for the department.
- Ensure all consent and privacy forms are signed.
- Enters routine to complex patient charges into billing system for physician or care provider visits, according to protocol.
- Communicates with insurance companies to obtain benefits, referrals, and/or authorization requirements.
- Communicates with Clinical/Office staff regarding patient eligibility, authorization status, and need for clinical documentation.
- Completes chart reviews to submit all appropriate documentation to insurance companies for authorization purposes.
- Works directly with RN, APRN, and MD level staff to notify of denials requiring further action.
- Coordinates with Utilization Review for status designation of Outpatient/Inpatient Admissions.
Experience & Skills Required
- High School diplomaIntermediate knowledge of MS Word and Excel
- ADT systems and Insurance Verification systems (EPIC preferred)
- Knowledge of Managed Care, referral/pre-certification/ authorization process.
- Knowledge of HIPAA regulations and compliance