Surgery Center of Appleton - Full Time Patient Benefits Coordinator

Regent Surgical•Appleton, WI

About The Position

Under the direction of the Business Office Manager, the Insurance Verification Specialist ensures patients have valid and adequate insurance coverage for surgical services. They verify patient information, insurance eligibility and benefits, and authorizations and referrals before treatment including communication regarding financial responsibilities. This role requires strong communication with patients and physicians’ offices, attention to detail, and knowledge of healthcare insurance plans and billing procedures.

Requirements

High school diploma or equivalent
Insurance verification or billing experience in a healthcare environment
BLS certification (as required by individual ASC policy)

Nice To Haves

Two years of insurance verification or billing experience in a healthcare environment

Responsibilities

Verify insurance coverage by confirming patient’s insurance eligibility and benefits with various providers (HMOs, PPOs, Medicare, and Medicaid); document and update patient insurance details in the system and maintain up-to-date records.
Investigate and resolve discrepancies in insurance information attached to patient account.
Ensure valid authorizations were received from physician’s office for the scheduled procedure; confirm by contacting insurance companies and contacting physician’s offices in the event of missing authorizations.
Communicate coverage details, and financial estimates to patients prior to services rendered; obtain payments for procedures; address insurance-related inquiries.
Collect any outstanding balances; inform revenue cycle when account has outstanding insurance balance.
Document all necessary information to the billing department for accurate claims processing.
Adhere to HIPAA and other relevant regulations.
Understand and apply ICD-10, CPT, and HCPCS codes when verifying coverage.
Remain current on all case verification; standard operating procedure is two weeks prior to date of service.
Notify the Business Office Manager in the event of insurance or authorization discrepancies or balances due.
Run daily reports to ensure all cases are verified, authorized, and financial counseling is complete.
Perform other duties as assigned.