Insurance Verification/Financial Counselor
- Job Title
- Insurance Verification/Financial Counselor
- Job ID
- Statesboro, GA 30458
- Other Location
Job Purpose: The Authorization Specialist is responsible for insurance verification processes of verifying patient eligibility, coordinating medical benefits, gaining approval for planned procedures and services, and determining patient coverage / responsibility for services to be provided.
- Verify private, government and third party insurance information, including eligibility, out-of-pocket costs, prescription coverage and patient portions.
- Verify any secondary and tertiary medical insurance benefits.
- Obtain, review and input insurance authorization and referrals prior to patient services, and throughout treatment to maintain continuance of authorizations. Advocate for the patient utilizing knowledge of coverage based guidelines and treatments.
- Provide accurate and timely estimated patient responsibility amounts to patient service staff members.
- Monitor and track patient authorizations, obtain updated authorizations for ongoing treatment, and communicate changes to appropriate team members.
- Identifies and provides accurate CPT/ICD codes where needed for reimbursement.
- Maintain appropriate logs and reports to professional, state and federal requirements; including but not limited to Medicaid, Medicare, case logs and drug logs.
- Obtains, interprets and submits clinical documentation pertinent to the specific services requiring prior authorization to support medical necessity reviews by the payer.
- Follows up on denied authorization requests, escalates to appointed appeal personnel, and relays the necessary denial detail to the provider to facilitate the appeal and/or peer to peer reviews.
- Work closely with clinical and front office staff to ensure smooth collection process.
- Maintains appropriate documentation in clinic systems and EMR.
- Responsible for monitoring and collecting the financial balances owed by our patients during their course of treatment.
- Meet with patients to explain cost of treatment, insurance coverage, and patient financial responsibility.
- Coordinate insurance verification information amongst onsite and offsite staff to ensure correct balance is obtained, and/or estimate to be given.
- Provide a standard cost estimate to the patient within the initial weeks of treatment. Must be able to explain/differentiate between set commercial rate vs. Medicare/Medicaid allowable.
- Use all information obtained to update company financial records to include data showing in both Centricity and the EMR. This information is shared by offsite billing and onsite Front Desk for the purposes of insurance and patient collections.
- Review all payment / financial options directly with the patient. Be sole contact for a Financial Assistance application and understand how to calculate poverty level from Federal Poverty Guideline provided.
- Assist patients with questions regarding billing, insurance and patient balances appearing on monthly billing statement.
- Monitor and update balances daily, to be forwarded to the front office staff detailing the amount of money to collect from each patient.
- Regular attendance and punctuality.
- Contributes to team effort by accomplishing related results as needed.
- Ensures that all processing and reporting deadlines are consistently achieved.
- Perform any other functions as required by management.
Qualifications and Education Requirements
- Minimum of 2 years in this field or related field such as medical coding, financial counseling setting or similar service profession.
- Strong knowledge of ICD9/10 diagnosis codes, as well as CPT codes.
- Must be proficient using a computer, online websites, and email.
- Knowledge of basic medical terminology
- Ability to work a flexible schedule including overtime as necessary.
- High school graduate or equivalent
- Previous oncology background preferred
Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.
Physical Demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing.
Work environment: Required job duties are normally performed in a climate-controlled office environment.
Option 1: Create a New Profile
Our executive team doesn’t hide the fact that they care. Patients come first. Period. It’s refreshing in today’s business environment to know that the bottom line is more than profits.
There’s nothing better than being part of a team that makes a difference in the world. Every person contributes to the quality of experience our patients and families have.
We prosper as a company when we grow as individuals. We are committed to being the best we can be by empowering our team members to grow personally and professionally.
Commit to something big
There are many benefits to being part of the e+CancerCare team – including competitive pay, health insurance, paid time off, 401(K), ongoing training, team member assistance program and service days. But at the end of the day, we believe the most important benefit is making a difference in the lives of our patients and their families.
I’ve been with e+ for over seven years. We’ve grown rapidly over that time but haven’t lost the family feeling. I love that any teammate in the company will help each other out to do what’s best for our patients.Chris Burgess, Vice President of Clinical Operations
I am surrounded by an awesome management team, nurses and peers. The home office gives us a lot of autonomy to do what's best for our patients, families and communities.Brittany Fortie, Lead Nurse, Oncologics and Lafayette General Hospital
You hear people say, ''we’re a family,' but at e+ it’s not just words, you actually feel it. Everybody is so happy and caring. I love working here and getting a chance to brighten the day for our patients and families.Jamie Gilbert, Patient Concierge, Oncologics, New Iberia