Responsibilities
- Identifies patients who need pre-certification or pre-authorization when services are requested or upon departmental notification.
- Monitors and follows up on accounts flagged by system alerts.
- Reaches out to insurers or employers to confirm patient eligibility and coverage details for planned services.
- Collaborates with patients, insurers, or providers to resolve insurance-related issues and secure financial clearance.
- Utilizes EPIC system work queues for managing appointments, care transitions, and billing corrections.
- Conducts medical necessity reviews as required by third-party payors.
- Records referral, authorization, and certification numbers accurately in the EPIC system.
- Initiates charge anticipation estimates to identify expected self-pay portions with precision.
- Informs patients of anticipated out-of-pocket costs, including co-payments, deductibles, and co-insurance, and refers those with limited coverage to Financial Counselors.
- Supports denial management by assisting with appeals, particularly those related to medical necessity.
- Reports workflow obstacles to supervisors promptly.
- Evaluates self-pay patients for eligibility in public assistance programs and provides financial counseling resources; stays updated on key payer reimbursement policies.
Work Arrangement
Hybrid
