Job Description Summary
The Insurance Coordinator is responsible for the admission process and insurance verification for patient referrals to the Outpatient Cardiac Rehabilitation department. Responsible for ensuring compliance with third-party payer requirements and acting as a liaison between the department and the insurance company’s advocates for the patient to ensure appropriate receipt of benefits and coordination of cardiac rehabilitation services.
The Insurance Coordinator role encompasses all functions of the intake and new referrals processes in the outpatient cardiac rehab department. Utilizing the EPIC EMR, responsibilities include checking patients in, scheduling appointments, copayment collections, and phone follow-ups with newly referred patients. Also responsible for performing the various steps of the admission process and insurance verification for patients and referrals for the outpatient cardiac rehab department. Assists with the process of insurance verification in compliance with third-party payers. Supports the cardiac rehab team members (nurses, exercise physiologists, dietitian) with all front desk tasks that are needed for daily operations. Connects with various MD provider groups who refer patients to cardiac rehab in obtaining MD orders, stress test results, office notes, procedure, and operative report summaries.
Demonstrates effective communication skills and proven organizational and interpersonal skills. Strong skills are needed for phone follow-ups and interviewing prospective patients referred to the program. Knowledge of medical terminology and clinical knowledge, demonstrated basic knowledge base and experience with third-party reimbursement, and computer technology.
Job Description
Main Job Responsibilities:
- REQUESTING SERVICES/PROVIDING PROGRAM INFORMATION: Responds to incoming calls requesting services and information regarding programs offered for Cardiac Rehab Services, completing insurance intake information from patients, physicians, and other sources.
- PRE-AUTHORIZATION: Creates an accurate database for all patients and verifies third-party coverage. Demonstrates independence, proficiency, and accuracy in obtaining referral information. Consistently completes insurance tracking accurately and makes any updates in the referral shell. Consistently obtains pre-authorizations/certifications for services per payer guidelines before the initial date of service.
- OBTAINING LETTERS OF MEDICAL NECESSITY: Works with patients referring MD if medical necessity is required before booking the initial appointment for cardiac rehab services.
- CARDIAC REHAB PROGRAM ENROLLMENT: Responsible for the successful collection of all necessary documentation from patients, physicians, and other facilities for patients entering the Cardiac Rehab program and provides clerical support to the department as needed.
- CUSTOMER SERVICE/CHECK-IN: Greets and acknowledges all patients and visitors, both in the office and on the telephone, with professionalism and directs to appropriate services.
- PRE-REGISTRATION AND REGISTRATION: Completes pre-registrations and registrations with respect for patient privacy, ensuring the complete collection of referral information, including accurate patient demographics per department standard.
- SCHEDULING APPOINTMENTS: Schedules cardiac rehabilitation appointments efficiently to maximize optimal utilization of resources and patient access to services.
- CO-PAYMENT COLLECTION: Adheres to department standards for timely collection of co-payment, completing all documentation and delivery according to department standards.
- LONG TERM PROJECTS AND DAILY ASSIGNMENTS: Works independently to complete daily assignments by the end of the shift and long-term assignments by established deadlines.
- TECHNOLOGY: Embraces technological solutions to work processes and practices.
FULLTIME: 40 HOURS/WEEK
SCHEDULE: Mon-Friday 8AM-4:30PM
Minimum Education - Preferred: High School Diploma or GED preferred.
Minimum Work Experience: Two (2) years business office and health insurance verification and referral management experience preferred. Previous health care environment experience of two (2) years preferred.
Required additional Knowledge and Abilities: Demonstrates effective communication skills and proven organizational and interpersonal skills. Knowledge of medical terminology and clinical knowledge, demonstrated knowledge base and experience with third-party reimbursement, and EPIC EMR computer technology.
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