Patient Insurance Coordinator

SUMMARY OF POSITION:

The Patient Insurance Coordinator will verify insurance eligibility and benefits for our patients as well as obtain required pre-certifications and/or verify medical necessity is met for Provision Imaging. The team will communicate with imaging patients once services are scheduled to begin to complete required documents and collect as much as possible of the patient’s estimated out of pocket responsibility. The goal of our team is to help keep patients informed throughout the insurance process, keep down claim denials for more timely collections, as well as collecting the patient’s portion for services rendered to help minimize the need for patient statements.

JOB RESPONSIBILITIES:

• Verify insurance eligibility & benefits in full detail, including type of coverage, i.e., fully funded vs self-funded. Update patients’ electronic chart which will include a clear explanation of insurance coverage, patient benefits, and the insurance company policy if available.
• Communicate with patients prior to imaging appointments, as well as if the patient requests a meeting with the finance team. Calculate the patient’s cost for services rendered and collect this at the time of pre-treatment services or set up applicable payment plan.
• Work with insurance carriers to obtain needed authorizations for imaging services. Obtain GAP Exceptions/Network Waivers for patients who are insured by a plan that is out of network at our facility. Making sure to maintain frequent contact with outside providers as needed, the insurance carrier to stay up to date on case activity and keep the patient updated throughout the entire process.
• Work with patients to set up payment agreements for those who decide to pay for treatment on their own.
• Assist patients, who qualify, with the financial assistance process. Collecting needed application and supporting documents. Organize & submit complete file to reviewing committee. Inform patient of outcome once process is complete.
• Communicate within to keep the staff informed as their patients begin the financial process. Clear patients for imaging services or withdraw their case as needed.
• Request the front desk to obtain updated insurance cards at follow-up visits if needed. Obtain updated GAP Exceptions/Network Waivers for out of network patients seen in follow-up.
• Effectively and efficiently document each process into the required system(s).
• Assist the Billing Department when needed if claims are denied.

JOB SPECIFICATIONS:

• High school diploma required, Associates or Bachelor’s Degree is preferred
• Minimum of 2 years of experience working with insurance is required
• Pre-certification experience is preferred
• Pre-authorization for radiation therapy a plus
• Must have a strong understanding of insurance benefits, policies, and regulations, as well as how a policy pays and how to calculate what a patient will owe for services rendered
• Proficient computer skills with experience working in an EHR is required
• Ability to Multi-task
• Excellent attention to detail
• Strong verbal and written communication skills is necessary, as is the ability to work well in a team atmosphere
• Must be willing to spend large amounts of time on the phone
• The normal schedule for this position is 8:30am-5:00pm
• May be required to stay late or come in early at times

COMPETENCIES:

• Good typing and keyboard skills
• Strong working knowledge of Microsoft Word and Adobe Acrobat
• The ability to work with a variety of personality types and good customer service skills is vital
• The ability to work with frequent distractions, and still be able to correctly complete the task at hand
• Must be able to prioritize tasks and maintain scheduled team appointments as needed

RELATIONSHIPS:

• Reports to the Manager of Imaging Services