Address
Form of workJOB SUMMARY:
Insurance Verification and Authorization Coordinators primary duties include verifying insurance eligibility; determining deductible, copay, and prior balances to be collected; updating insurance when necessary. Insurance Verification and Authorization coordinators are also responsible for obtaining authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed. Insurance Verification and Authorization Coordinators may be required to provide coverage on secondary duties as Financial Counselor and for retina appointments.
Essential Job Functions
Verification
- Eligibility verification
- Verify eligibility as active staying a minimum of three days ahead of scheduled service.
- Verify eligibility as active for add on appointments, staying ahead of schedule and verifying eligibility the same day for services scheduled and performed on the same day.
- Use Phreesia or RTS to identify and correct inactive or incorrectly registered policies and address.
- Utilize payer websites for further verification when needed.
- Contact patients to update / obtain correct information when needed.
- Validate that the correct plan was chosen per the insurance guide and provide feedback to supervisor for feedback to upstream areas.
- Confirm network participation and advise patient of our provider’s network participation when needed.
- Forward new plans to supervisor for payer file updates.
- Document verification activities in NextGen to support productivity and quality tracking.
- Ensure NextGen system is updated.
- Copay, deductible, and prior balance verification
- Notate copays, deductibles, and prior balances to be collected.
Authorization & PCP Referrals
- Obtain authorizations, referrals, pre-determinations or any other payer pre-service approval as needed, staying a minimum of three days ahead of scheduled service, and ensuring that authorization, referral or pre-determination is obtained for add on appointments in advance or on the same day of service.
- Obtain vision plan authorizations, as needed.
- Obtain PCP referrals for HMO’s and provide feedback to supervisor on any particularly difficult or time-consuming PCP offices.
- Obtain prior authorization or pre-determination as needed for clinic and facility services.
- Obtain prior authorization for procedures as required by insurance plans.
- Work NextGen task list for procedures including but not limited to stents and cross-linking which require prior authorization approval or pre-determination.
- Review MDI Pending notifications for imaging orders and obtain prior authorization for those which need approval.
- Apply and use Dextenza (Dextenza360) portal for authorizations and support.
- Document authorization, referral, and pre-determination activities in NextGen.
- Adherence to applicable laws, regulations, and contractual obligations. Follows the principles of the Company’s Compliance Program as well as the Code of Conduct.
Other Job Responsibilities
Financial Counseling - Patient Estimation, Calculation, & Pre-service Collections
Patient estimation & pre-service collections
- Verify insurance eligibility and benefits for all appointments staying a minimum of three days ahead of scheduled service calculate out of pocket patient responsibility.
- Utilize Availity or other estimation tools to determine patient cost.
- Place outgoing calls to patients to address patient responsibility amounts due prior to appointment.
- Coordinates patient assistance applications for Division of Blind Services and other agencies.
- Document financial counseling activities in NextGen.
- Customer service (Internal & External)
- Answers calls via the Financial counselor phone queue and responds to emails from staff / providers
- In person counseling
- Assisting and guiding patients with application for financing.
Retina schedules
- Verifiy insurance eligibility and benefits for retina services
- Obtain authorization, referral or pre-determination for retina services.
- Contact the patient to provide estimated out of pocket for retina services.
- Assist with patient assistance applications for Retina patients.
- Document insurance eligibility verification, authorization, referral or pre-determination activities in NextGen appointment details and complete Insurance Verification templates. Document patient assistance activities in NextGen shared notes.
Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.
COMPETENCIES:- Demonstrated ability to follow oral and written instructions.
- Demonstrated knowledge of material, methods, instruments, and equipment.
- Demonstrated ability to read, write and perform mathematical calculations.
- Must be able to maintain high degree of confidentiality. Ability to multi-task, work in a fast-paced environment and manage time accordingly in order to meet deadlines and requirements of the organization.
The position has no supervisory responsibilities.
WORK ENVIRONMENT:
The work characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Fast-paced, deadline oriented, confidential department. The noise level in the work environment is usually moderate.
PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Demonstrated ability to do excessive walking, standing, bending and stooping. While performing the duties of this job, the employee is frequently required to stand, sit, use hands to handle or feel objects, tools or control, reach with hands and arms and talk or hear. The employee is occasionally required to climb or balance, kneel and crouch.
The employee may be required to lift moderately heavy objects (50-90 pounds). Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
POSITION TYPE AND EXPECTED HOURS OF WORK:
This is a full-time position. Days and hours are Monday through Friday 8:00 A.M. – 5:00 P.M. with occasional overtime.
TRAVEL: Travel may be required.
REQUIRED EDUCATION AND EXPERIENCE:- A high school graduate or equivalent
- Proficient in computer and typing
- Knowledge of Microsoft Office products (Word, Excel)
- Excellent customer service skills in phone, person or via email
- Ability to manage multiple, ongoing tasks while maintaining professional composure.
- Have an understanding of insurance and medical terminology.
- Bachelor’s Degree
