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Patient Benefit Coordinator / Patient Accounts / Full Time

The patient benefits coordinator provides personal care and professional excellence by identifying and verifying insurance benefits and initiating precertification for inpatient, observation, OB care, and outpatient services requiring case management. Also assists the Financial Services division with data analysis, clerical support, quality control, and patient account maintenance duties.

Major Tasks, Duties and Responsibilities:

• Obtain registration and scheduling documentation from appropriate ancillary departments as well as surgery.
• Verifies insurance eligibility of each registration / preregistration case.
• Makes corrections to insurance as needed.
• Contacts physician’s office for current insurance information if needed.
• Initiate contact with insurance companies and third-party payers for each case.
• Initiate precertification for any case that requires case management.
• Obtains supporting documentation as needed for procedure precertification.
• Document benefit information for each case, including contact name; deductible / coinsurance information; pre-existing exclusions; requirements for PCP referrals; and benefit payment limitations in the account notes and benefit verification form.
• Verifies eligibility for inpatient and observation cases requiring clinical contact on the part of the utilization review staff with the third party payer.
• Obtains clinical contact information for the UR nurse.
• Inputs admission into MCG.
• Professionally communicates with physicians, staff, and patients regarding benefit information.
• Professionally communicates with physicians, staff, and patients to obtain supporting clinical information as requested by insurance companies to authorize services.
• Completes forms as required by insurance companies.
• Initiates appeals on precert denials within 30 days of notification, including supporting documentation.