General Summary:

Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.
2. Initiates and tracks referrals, insurance verification and authorizations for all encounters.
3. Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.
4. Works directly with physician's office staff to obtain clinical data needed to acquire authorization from carrier.
5. Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.
6. Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements.
7. Reviews and follows up on pending authorization requests.
8. Coordinates and schedules services with providers and clinics.
9. Researches delays in service and discrepancies of orders.
10. Assists management with denial issues by providing supporting data.
11. Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing.
12. Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.
13. Assists Medicare patients with the Lifetime Reserve process where applicable.
14. Reviews previous day admissions to ensure payer notification upon observation or admission.
15. Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).
16. Performs other duties as assigned.