Initiates and coordinates insurance or other carrier pre-certification and prior authorization for patients. Provides financial counseling to patients. Coordinates with the business office to ensure timely claim and account follow-up. Assists with interviews and performance evaluations. Trains and supervises Patient Account Navigators. 

• Completes the pre-certification process communicating with the patient, physician, insurance company, other financial institutions and the hospital.
• Interviews patient by telephone or in person to gather financial information in order to determine discounts that may be applicable. 
• Explains financial responsibilities for services received and payment options to patients and/or insurance or other financial institutes responsible for payment. 
• Counsels patients regarding insurance benefits and recommends alternative sources of payment and financial assistance when appropriate.
• Reviews provider and treatment protocols, determines insurance benefits and patient responsibility, establish payment arrangements with the patient, and documents appropriate practice management system.
•  Acts as an advocate for the patient when discussing medical care with the insurance carrier or other financial institute.  
• Checks patient's accounts for outstanding insurance claims over 60 days and communicates with the biller to request additional claim follow-up.
• Prepares medical necessity letters for the insurance companies and other financial institutes. 
• Receives and processes information and forms from the patient and insurance company.
• Assists patients with obtaining financial resources for oral medication prescriptions by working with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.
• Supervises Patient Account Navigators. Checks employees work to ensure accuracy. Assists with interviews and offers opinion of applicants. Trains new hires and conducts performance evaluations. Approves employee's time off requests.
• Diffuses all but the most serious situations. 
• Refers only major situations to senior leadership or appropriate personnel. 
• Keeps senior leadership abreast of all situations.  
• Performs various duties to successfully fulfill the function of the position.

Education:

Required: High diploma or GED.

Experience:

Required: 24 months experience in pre-certifications, customer service, medical billing, accounts receivable or related experience.

Certifications or Licenses:

None

·        Advanced knowledge of HIPAA regulations and procedures.
·        Excellent verbal and written communication skills.
·        Ability to use a 10 key.
·        Must be detail oriented, complete work tasks, and meet deadlines.
·        Ability to maintain composure even in difficult situations.
·        Ability to read and interpret business correspondence, safety manuals, and policy manuals.
·        Ability to be understanding and sensitive to needs of others.

Physical:

• Sitting for prolonged periods.  Communicate effectively and listens. Use of computer and telephone.

Environmental:

• Standard Office Environment.