FinFinancial-Benefit Coordinator IIancial-Benefit Coordinator II

Center for Neurosciences•Tucson, AZ

3d•Onsite

About The Position

Verify insurance for all incoming referrals and obtain authorization for all codes based on visit type. Notify medical assistant to schedule. Accesses various insurance websites and initiates phone contacts as needed to check coverage benefits; submit prior authorizations and verify eligibility for proposed service. Responsible for determining if patient has in-network or out-of-network benefits (OON). If OON benefits, need to obtain OON authorization and/or gap exception and communicate to the patient the financial responsibility associated with OON physician. Verifies deductible/coinsurance/co-pays, authorization requirements, medical necessity and other relevant information. Submit authorization requests to the appropriate insurance company via fax, telephone or internet. Send appropriate documentation (such as dictation, imaging, lab work, etc.) needed to submit the authorization request. Prepares cost estimates. Calls patients at least four business days prior to scheduled service to inform them of what their financial obligation will be at the time of service for any financial obligation beyond $100. Collects payments and/or establishes payment arrangements, per policy guidelines, with patients and documents appropriately in the practice management system as needed. Contacts staff and physicians as needed for clarification of request for authorization. Ensure the proper priority is given to all authorization requests including STAT and urgent requests. Track and follow-up on authorizations that are pending submission because of dictation and/or other documentation. Track all authorizations submitted to insurance carriers and follow up as needed. Task the appropriate Medical Assistant when authorizations have been approved or denied. Documents activity and patient communication on patient's accounts; scans appropriate documentation to patient's account. Check out patients having a procedure and collect monies due. Performs other duties as assigned.

Requirements

High school diploma or equivalent.
Minimum two years of recent medical billing experience.
Some collection experience preferred.
Any equivalent combination of experience, training and/or education approved by the Billing Supervisor and/or Human Resources.

Responsibilities

Verify insurance for all incoming referrals and obtain authorization for all codes based on visit type.
Accesses various insurance websites and initiates phone contacts as needed to check coverage benefits; submit prior authorizations and verify eligibility for proposed service.
Determine if patient has in-network or out-of-network benefits (OON).
Obtain OON authorization and/or gap exception if OON benefits apply.
Communicate to the patient the financial responsibility associated with OON physician.
Verify deductible/coinsurance/co-pays, authorization requirements, medical necessity and other relevant information.
Submit authorization requests to the appropriate insurance company via fax, telephone or internet.
Send appropriate documentation (such as dictation, imaging, lab work, etc.) needed to submit the authorization request.
Prepare cost estimates.
Call patients at least four business days prior to scheduled service to inform them of their financial obligation.
Collect payments and/or establish payment arrangements, per policy guidelines, with patients.
Document appropriately in the practice management system.
Contact staff and physicians as needed for clarification of request for authorization.
Ensure proper priority is given to all authorization requests including STAT and urgent requests.
Track and follow-up on authorizations that are pending submission because of dictation and/or other documentation.
Track all authorizations submitted to insurance carriers and follow up as needed.
Task the appropriate Medical Assistant when authorizations have been approved or denied.
Document activity and patient communication on patient's accounts.
Scan appropriate documentation to patient's account.
Check out patients having a procedure and collect monies due.
Perform other duties as assigned.