Description:
This person will be responsible for reviewing authorizations, requesting extensions, and workers compensation.
Qualifications:
- Five years minimum of insurance authorization experience
- Experience working with and authorizations with different types of insurance companies (BCBS, Atena, Humana, Tricare and so on)
Job Responsibilities:
- Patient Care Coordination
- Answer phones and take care of patients’ questions and concerns
- Provide customer service
- Schedule equipment set-ups and pick-ups
- Get all required information (i.e. verify address, directions, payment information, etc) to set up a patient with equipment
- Follow up with total knee replacement patients and/or post- op patients to find out discharge date from hospital/status
- Handle all incoming pop-up orders accordingly
- Billing
- Request authorization for any type of insurance, including medicare Replacement HMOs, commercial insurances, etc.
- Initiate referrals process with Medicare HMO plans
- Assure that insurance gets verified electronically or via phone
- Ensure that diagnosis and HCPS and units are correct and match item provided to patient, as well as authorization
- Familiar with billing process
- Initiate appeals process for denied authorizations
- Initiate workers compensation authorizations, negotiate pricing with adjusters and third parties
- Administrative
- Maintain tracking boards
- Create cards for all orders
- Track progression from Probability→To Be
- Maintain Patient Tracking Log
- Create schedule for Patient Care Representatives
- Record meeting minutes
- Track overdue script list
- Distribute faxes
- Enter/track order in Cortex, in Busy Cal, in the Patient Tracking log
- Create files for all orders
- Make sure all necessary information is in the file
- Request clinical notes from doctors’ offices
- Assist Office Manager and Billing Coordinator
- Insurance Verification/Payment Arrangements
- Verify status of patients’ insurance, auto or workers compensation coverage
- Offer patients private pay rate for non-covered equipment and non-covered rental extensions
- Coordinate Patient Care Representatives Schedule
- Print a daily schedule listing all set-ups and pick-ups
- Include set-up tickets with maps and directions
- Include pick-up tickets with maps and directions
- Include any equipment exchanges
- Supply accurate directions and maps to locate patients home
- Coordinate weekend schedule
- List all scheduled set-ups
- List all possible set-ups