About the Role
This role is responsible for verifying insurance benefits, obtaining authorizations, and ensuring financial clearance for patients with out-of-network or special coverage plans. The representative will coordinate with providers, insurers, and patients to confirm coverage and resolve financial eligibility issues.
Responsibilities
- Verify patient insurance eligibility for out-of-network services
- Obtain pre-authorizations and referrals for specialized care
- Review and interpret insurance policies and benefit plans
- Communicate with insurance companies to confirm coverage details
- Ensure accurate patient financial responsibility estimates
- Resolve insurance denials and coordinate appeals
- Maintain up-to-date knowledge of payer policies
- Support patient billing and payment planning processes
- Collaborate with clinical teams to verify service requirements
- Document financial clearance activities in patient records
- Adhere to HIPAA and patient privacy regulations
- Process insurance verification requests within service timelines
- Identify coverage limitations and exclusions
- Assist patients with understanding financial obligations
- Coordinate with third-party payers and internal departments
- Maintain accurate and timely case documentation
- Follow up on pending authorizations and approvals
- Support accurate charge entry and claims preparation
- Participate in process improvement initiatives
- Respond to internal and external inquiries about coverage status
Compensation
Competitive salary based on experience and qualifications
Work Arrangement
Onsite
Team
Part of the revenue cycle management team supporting outpatient and specialty services
Special Coverages
- This position focuses on complex insurance scenarios including self-funded plans, workers' compensation, and third-party liability cases.
- Requires coordination with legal and risk management teams when necessary.
Out-of-Network Services
- Primary responsibility includes verifying benefits and obtaining approvals for services rendered outside network agreements.
- Involves detailed communication with patients about potential out-of-pocket costs.
Not available
