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ESSENTIAL JOB RESPONSIBILITIES

• Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for scheduled procedures.
• Enters patient insurance information into the patient record and documents insurance coverage of services to be provided.
• Determines financial responsibility for services to be provided. Notifies patients and/or practitioners of any services requested and/or referred that are not authorized by insurance.
• Communicates with patients and practitioners regarding financial responsibility and insurance coverage issues.
• Assists with payment status and maintains department status reports and logs. Investigates referral denials and acts as a liaison between provider, hospital personnel, and selected payors.
• Coordinates and completes insurance referral processing system following department protocols.
• Handles phone inquiries as well as trouble shooting directly with patients, payors, providers, medical office staff, and testing departments.
• Works with testing departments, providers, and their staff to collect data for Utilization Review. Keeps appropriate logs for test tracking and follow up. Works with a specialist assuring adequate information flow between specialist and referring PCP as assigned.
• May enter, review, and submit charges for patient procedures and services daily.
• Complies with CLIA, OSHA, and other regulatory agency standards. Participates in in-service programs as needed. Follows infection controls and safety policies.

QUALIFICATIONS/REQUIREMENTS

The qualifications/requirements listed below are representative of the knowledge, skill, and/or ability required.

?COMPLEXITY OF WORK: Within scope of job, this position requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment.
? PERSONAL PROTECTIVE EQUIPMENT: Follows Standard Precautions using personal protective equipment as required.
? EDUCATION and/or EXPERIENCE: High school diploma or equivalent required.
? CERTIFICATES, LICENSES, OTHER: N/A
? WORK EXPERIENCE: Six (6) months of medical office experience required.