Job Description

• Works under general guidance.
• Able to establish priorities and meet tight deadlines with strong problem-solving ability
• Exercises a high degree of control over confidential medical information.
• Inputs and updates all insurance information in appropriate screens.
• Verifies eligibility of all insurances available online or by phone.
• Identifies primary and secondary insurance. Inputs insurance information in correct COB order.
• Obtains claim numbers and verifies that claims are established for Workmen’s Comp and Auto Insurance.
• Identifies the need for pre-authorization information, makes decisions relating to insurance eligibility utilizing several online systems available at MMC. Scheduled patients: Obtains and documents pre-authorization as appropriate for procedure. Emergent patients: obtains pre-authorization guidelines and communicates information to Utilization Management.
• Follow up on all verification issues in a timely manner and communicate information to proper departments regarding information obtained.
• Responsible to keep current on billing requirements from third parties such as, Blue Cross/Blue Shield, Medicare, Medicaid, and all other health insurance carriers.
• Performs insurance verification, obtains pre- and retro- certification information for all inpatient activity. Communicates appropriate information to the Utilization Management team as required.
• Refers patients to Financial Counselors to obtain financial assistance and /or payment arrangements when appropriate.
• Interprets and initiates problem solving, prioritizes work activity.
• Keeps educational information, manuals and guides at team level updated and current.
• Works various reports.
• Meets productivity and quality standards.
• Identifies and documents patient financial liability.

Qualifications

• 2 Year / Associate Degree or Equivalent experience
• 1.5 years of related experience in healthcare

Additional Information

Key Competencies and Skills

• Advanced keyboard, mouse, computer and Microsoft Office skills. Must have knowledge and ability to learn, access and utilize 10+ of the computer programs listed below within 90 days of hire.

• Outlook

• Star

• Insurance Verification systems

• Smart Web

• Power Chart

• First Net

• 3M Coding

• Ontrac and related tools

• NextGen

• Cerner

• Must possess exceptional oral and written communication skills. Ability to demonstrate effective communication with patients, Dr’s offices and technicians within hospital departments, and create accurate documentation with information gathered. Must be warm, friendly, and sensitive to the feelings and concerns of others.

• Ability to demonstrate effective communication with Insurance companies to obtain, verify, and create accurate documentation with information gathered.

• Ability to perform online insurance verification through the Internet.

• Must demonstrate ability to adapt to change and keep up with continued advanced education requirements.

Munson Healthcare requires all employees be vaccinated or have lab confirmed immunity for Measles, Mumps, Rubella and Varicella. MHC also requires all employees to receive a flu vaccine during the flu season in the year that they are hired and annually thereafter, or receive an approved medical or religious exemption.