Northwest Florida ENT is looking for a team member to help verify insurance profiles for all patients scheduled for surgery/procedures and date of service for all providers at Northwest Florida ENT while providing communicating to patient’s their responsibility as it applies to deductibles, co-pays, co-insurances; confirming payments are made at time of service. Able to assist with medical office responsibilities as needed.
Responsible for the accuracy and timely completion of all insurance verification responsibilities from the Daily Scheduling Work Flow weeks in advance.
Monitors changes in Work Flow during the day to facilitate add-on cases for all providers.
Ensures resolution of conflicting insurance information when presented during the verification of patient insurance information, informing physician’s offices, seeking timely clarification from all sources including physician office, patient, and/or insurance company.
Proficient at navigating multiple insurance sites to assure all information is accurate, reading all disclaimers and understanding the various impacts on the planned procedure as it applies to each insurance payer profile for each patient profile-such as screenings balloon sinsoplasity, allergy, CT scans, physical therapy, hearing aids, and home sleep study.
Consistently demonstrates the ability as a professional to be an integrated member of the business office team meeting all additional responsibilities as assigned to the business office. Example (phone calls, inter-department communication needs, patient registration, scheduling, medical record management, etc).
Updates existing patient accounts information in regard to insurance profiles.
Proficient in understanding and navigating all health insurance profiles
Familiarity with CPT coding(ENT, Allergy, Sleep Studies, Physical Therapy, Audiology, etc) and ICD-10 formats.
Possesses strong understanding of Patient Bill of Rights, Responsibilities and HIPAA.
Assures documentation of authorization or letter of approval is provided by the case manager/adjuster prior to date of service and scanned as part of the record.
Ensures correct documentation of all Military/VA case confirms authorizations are active for the time period the procedure is scheduled.
Calculates quotes as directed by facility Policy for all self pay, and procedure cases including anesthesia as needed.
Communicates directly to self-pay and patients their financial responsibility, informing patients that payment is due day of service.
Verifies physician’s office cross coding for Diagnosis and CPT procedure are appropriate for utilization purposes.
Directly inquires need for precertification and/or authorization from commercial insurance, HMO, and Medicaid vendors.
Ensures that all insurance coverage is active within the date of service timeframe.
Communicates directly with patient delinquent account balances (bad debt), tracks to confirm payment in full has been paid prior to upcoming date of service.
Reviews estimated fees and coverage available with the patient/family, explaining the fees and reimbursement process; documents the review in the patient case/insurance tab for the date of service.
Determines and collects patient Share of Cost for upcoming procedures. Verifies patient insurance. Uses Availity or calls insurance company to determine patient coverage for procedure (CPT) codes. Informs patient and collects for procedure. Documents in patient chart.
Consistently documents all conversations of record by utilizing electronic medical records(AthenaNet) with placing detailed notes for accurate record keeping of all discussions with insurance vendors, and patients/family.
Includes ABN in all insurance/cosmetic quotes, providing patient with a full understanding of reason for facility’s need and securing signature.
Assists with training current team members of the business office and new employees not only in regard to insurance but all areas of knowledge, ensuring the business office team’s ability to adequately function when individual team members are unavailable to the facility
Willing to cross train in other areas in the Business Office. Performs other duties as assigned.
Education High School Diploma or GED equivalent. BS degree preferred.
Minimum Three Years In Medical Business Office Environment Preferred.
Previous responsibility specific to healthcare insurance, verification, authorization process.