Communicates with patients, third-party payers, physicians, and clinics by telephone, email, or U.S. Mail.
Maintains extensive working knowledge regarding the authorization process for bariatric surgery with the ability to differentiate criteria between the multitude of payers.
Completes patient interviews to obtain health insurance information, health history and anthropometrics to assess for potential bariatric surgery candidacy.
Schedules consultation and seminar appointments.
Provides extensive patient education related to health insurance benefits, policy and program criteria as well as steps needed to quality for bariatric surgery.
Maintains regular communication with patients throughout surgical preparation process.
Monitors individual patient progress toward meeting necessary insurance, surgeon and program criteria for surgical readiness.
Provides customer service to prospective patients, outlining available services which actively contributes to program growth.
Works with pre-admission testing department to coordinate timely care relative to time of surgery.
Obtains medical records/clearances from physicians and clinics.
Processes faxes and incoming mail.
Verifies insurance coverage/benefits with third party payers for all surgical related procedures.
Obtains authorization for required post-bariatric surgery procedures.
Navigates insurance and hospital based software systems i.e. WebDenis, Health Nautica, etc., in conjunction with the Hospital's Utilization Review department guidelines to ensure appropriate surgical and hospital stay designations.
Compiles and maintains surgical scheduling logs and patient data base systems.
Accesses appropriate information systems for retrieval/input of information, charge entry, cash posting support.
Submits for insurance approvals.
Participates in appeal process with the provider, patient and insurance company.
Works with other in-house departments to coordinate scheduling of surgery, including pre-surgical testing and educational appointments.
Maintains surgeon schedules related to surgeon and operating room availability, patient readiness and insurance authorization dates for bariatric surgery.
Schedules esophagogastoduodenoscopy's for eligible patients.
- Performs other related duties as assigned. Utilizes new improvements and/or technology that relate to job assignment.
