Responsible for the verification/documentation of insurance benefits, securing pre-certification/referral numbers and estimating/collecting patient liabilities on all outpatient scheduled procedures.

Reports to: Patient Access Supervisor

Ensures that pre-certifications required by managed care companies for scheduled surgeries and procedures are obtained on a timely basis and documented in advance of appointment

Notifies physician offices and centralized scheduling in the event pre-cert is not obtained in time for patient appointment

Heavy phone and payer website contact in accordance with payer pre-cert and verification regulations

Communicates with insurance payers regarding any CPT code discrepancies or changes made due to radiologist discretion

Performs insurance verification, eligibility and pre-certification for outpatient scheduled procedures.

Maintains current knowledge of outpatient imaging policies and procedures

Verifies the patient has active insurance coverage and obtains insurance benefits utilizing insurance eligibility tools, payer websites and payer phone systems

Communicates with Benefits and Notification Specialist whenever a patient has no verifiable insurance benefits to cover a scheduled procedure

Works closely with physician offices and departments of the hospital when obtaining clinical information, providing them with necessary information or forwarding relevant documents to them.

Creates and explains patient liability estimate for all scheduled and add-on procedures

Contacts patient or physician offices when insurance information invalid or termed for all scheduled procedures

Provides registration functions, as needed

Minimum Education
High school diploma or equivalent - Required

Minimum Education
Two years of college or medical office specialist education - Preferred

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Must be able to function appropriately in a multi-task setting. Working knowledge of managed care and third party payors

Minimum Work Experience
One year experience with obtaining and verifying pre-certifications with various insurance companies Required.