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Responsibilities
Process insurance verifications for the Access to Care department:
• Runs and researches all consumers that present with or without insurance through Medicaid, Medicare, and other commercial insurance eligibility websites as appropriate
• Completes financial information and eligibility.
• Notifies Finance and Accounting, CarePointe and Center staff of any changes, requirements, and daily deficiencies as appropriate.
• Obtains appropriate prior authorizations as needed for services.
• Works closely with department staff to ensure that financial information is secured and correct on consumers, including that the consumer’s record has appropriate up-to-date insurance verification information.
• Maintain ongoing communication with Finance and Accounting, CarePointe and other staff of any changes or requirements as needed.
• Ensures consumers are assigned to the appropriate clinicians, as appropriate, based on insurance.
• Provides coverage in department as needed and other duties as assigned.
Responsible for ensuring payor source and funding information for Hospital Admissions:
• Obtains payor source and ensures funding information is obtained on all voluntary and involuntary adult and child hospital admissions.
• Verifies insurance eligibility and benefits, including coverage, co pay, and deductibles as necessary.
• Accurately populates and loads all fields in the Avatar system as related to the patient’s insurance and guarantor rankings.
• Completes preadmissions according to petitions received and consumers listed on weekly court docket.
• Ensures that all notifications and authorizations are completed with the required time frames.
• Communicates financial information to hospital and admission staff.
• Reviews daily census reports checking for accuracy and after hour admissions.
• Tracks and ensures that Medicaid and Medicare coverage is current or reactivated.
Supervision and Consultation:
• Seeks supervision and consultation as needed.
• Accepts and employs suggestions for improvement.
• Actively works to enhance skills.
Courteous and respectful towards consumers, visitors and co-workers:
• Treats consumers with care, dignity, respect and compassion
• Respects consumers’ privacy and confidentiality
• Is pleasant and cooperative with others
Administrative and Other Related Duties as assigned:
• Completes assigned tasks in a timely manner
• Works in a cooperative manner with other AltaPointe employees
• Follows AltaPointe policies and procedures
• Receives and respond to inquires of accounting matters promptly and courteously
• Must perform all duties with the highest standard of accounting ethics
Qualifications
High school diploma or equivalent; Associates degree preferred
Must be computer literate, detail oriented, dependable, focused, detail oriented, and able to multi-task as well as have strong communication skills and follow through with deadlines Proficiency in Microsoft office applications such as Excel and Outlook
Experience verifying and accessing outpatient and inpatient insurance eligibility, authorization, and billing (commercial, Medicare, Medicaid, etc) is strongly preferred
Working knowledge and familiarity of medical insurance policies is strongly preferred
