Community Memorial Hospital, Hamilton

Compensation

Full Description

Responsibilities And Duties Insurance Verification & Eligibility • Verify patient insurance coverage and benefits before inpatient admissions or outpatient procedures. • Confirm details such as policy status, copays, deductibles, and service coverage. • Contact patients ahead of scheduled services to verify demographics and insurance information Authorization Requests • Check and verify outpatient Authorizations and submit prior authorization requests for inpatient insurance payers (Medicare, Medicaid, HMO, PPO). • Ensure that all required data elements (CPT codes, diagnosis codes, clinical documentation) are included. • Handle both elective and urgent/emergent inpatient admissions and outpatient surgical/day care procedures. Follow-Up & Case Management • Track pending authorizations and follow up with insurers to secure timely approvals. • Escalate cases with potential financial clearance risks to management. • Maintain accurate records of authorization status for each patient encounter. Communication & Coordination • Act as a liaison between patients, providers, and insurance companies. • Answer incoming calls related to pre-authorization support and provide case handling. • Coordinate with scheduling staff to ensure services are not performed without proper authorization. Compliance & Documentation • Ensure compliance with payer requirements and hospital/clinic financial clearance programs. • Document all authorization activities in patient records and billing systems. • Maintain tracking system and follow up on pending authorizations • Support revenue cycle integrity by preventing claim denials due to missing authorizations. • Verifies physician order for testing and contacts patient to preregister • Performs other duties as assigned Qualifications Education & Experience: • 1-2 + Years in a Healthcare environment • Basic understanding of insurance authorization process • Experience in Patient Access or Billing • Strong Insurance knowledge • Basic understanding of medical terminology Skills & Competencies • Use of various insurance portals • Knowledge of each individual insurance company’s rules and regulations • Works as a vital team member with good time management skills and tasking important items • Work independently requiring a minimum of detailed supervision and guidance • Responsible for maintaining own individual case load