INSURANCE VERIFIER (FULL-TIME)
- Responsible for monitoring and verifying financial information to assure coverage for transplant. Keeps team informed regarding patients' insurance coverage and necessary follow-up needed to verify and/or extend coverage. Performs duties in accordance with the Department's Policies and Procedures and Service Standards. The financial counselor will be responsible for inpatient and outpatient blood & marrow transplants, as well as outpatient clinic visits. In addition, this position is responsible for HLA daily audit.
- Responsible for monitoring and verifying insurance.
- Acts as insurance liaison between the patient, transplant team, physician, billing office, Health Information Management (HIM) and insurance company to assure proper authorizations are received.
- Documents patient's insurance coverage on the insurance authorization form, coverage amount, applicable co-pays, name of person authorizing transplant, and the authorization number.
- Obtains re-authorization of insurance coverage in necessary time frame to assure no lapse in coverage.
- Enters pre-cert and authorizations in the computer so billing has access.
- Serves as a resource for patients and their family members on financial matters.
- Contacts patients and/or physicians and transplant coordinators to inform them of any insurance data updates, authorizations, and preferred providers.
- Responsible for correspondence related to medical requests and distribution of patient notes.
- Reviews requests and forwards to HIM for processing.
- Gathers and copies appropriate documents as requested by HIM and Billing Office.
- Collates and distributes patient documentation to insurance companies and State agencies.
- Assists the Billing Office as necessary. Familiar with and able to utilize Meditech modules including Office Automation (OA), Billing/Accounts Receivable (PBAR), Patient Care Inquiry (PCI), Resource Scheduling, Admissions (ADM), Order Entry (OE), and Materials Management (MM) and all system upgrades as they occur.
- Identifies and effectively communicates financial information to transplant team members, patients and their families with emphasis on identifying any potential patient out-of-pocket liability.
- Maintains daily Medicare audit to insure accountability needed for the cost report.
- Is required to attend various meetings with the physicians, administration, and staff to relay insurance information and to obtain any necessary information on potential patients coming into our system.
- Processes charges from outside facilities for potential donors.
- Discuss with the donor what will be covered under the recipient's insurance. Find out if the donor has insurance and check to see if the donor insurance will cover any complication.
- Inform the donor what other financial responsibility they may have
- Inform the donor that being a donor may affect their ability to get health or life insurance.
- High School, Post High School Vocational/Specialized Training Preferred.
- Previous patient medical insurance experience, medical terminology.
- Must be able to travel to and from patient rooms, clinics, areas in hospital, and University Medical Group (UMG) Building.
- Answer telephone, develop office procedures, research information, input data into computer programs (knowledge of Excel, Access, Word), maintain filing systems, type 60 words per minute.
102-Saint Louis University Hospital - St. Louis, MO
Tenet Healthcare - 17 months ago
Tenet Healthcare Corporation is one of the largest investor-owned health care delivery systems in the nation.
• 80 hospitals