Perform duties within the billing and revenue cycle functions related to all aspects of patient account management, insurance verification, authorization requirements, billing, denials, patient interaction, account research, and insurance follow-up.

This position is responsible for supporting accurate and timely reimbursement by identifying and resolving insurance, authorization, demographic, coding and billing issues. The position works collaboratively with clinical staff, scheduling staff, referral coordinator, providers, patients, referring offices, and insurance payers to facilitate patient access, reduce delays, prevent avoidable claim denials, and support the financial health of the department.

• Determine whether insurance authorization or referral requirements apply to scheduled services.
• Obtain, initiate, or facilitate insurance authorizations when appropriate and within departmental scope.
• Identify incorrect or incomplete authorization information and work with referring offices, payers, and internal departments to correct discrepancies.
• Follow up on pending authorizations and referrals to prevent unnecessary delays in patient scheduling and care.
• Follow-up with insurance carriers (unpaid, denied, or delayed claims) and self-pay accounts.
• Maintain accurate and timely documentation of billing and insurance follow-up activities.
• Assist patients with questions regarding insurance coverage, authorizations, balances, deductibles, and coinsurance.
• Communicate directly with patients regarding their estimated financial responsibility for elective procedures and services prior to the scheduled date of service.
• Provide patients with estimated out-of-pocket costs for elective cases when information is available and in accordance with organizational policies.
• Coordinate with scheduling, clinical staff, and other appropriate departments to ensure financial clearance requirements for elective cases are addressed prior to the date of service.

Preferred Qualifications:

• Minimum of one year of patient billing, insurance verification, authorization, patient accounts, or revenue cycle experience preferred.
• Experience with medical billing and insurance processes.
• Knowledge of commercial insurance, Medicare, Medicaid, Tricare, and other payer requirements preferred.
• Experience with insurance authorization and referral requirements preferred
• Experience researching and resolving insurance denials and claim-related issues preferred.