1. Contacts insurance companies to determine patient’s internationalinsurance benefits. Verify patient eligibility and pre-certificationrequirements through On-line verification software, email or bytelephone 2. Obtains requirements for claim submission and pre-certificationprocess from insurance companies 3. Determines contract and benefit eligibility for pre-certification,prior authorization of inpatient and outpatient services 4. Works with patients in securing prepayment sources or financialagreements prior to providing service 5. Maintains the pre-certification related information in the system toensure its accuracy 6. Verifies the coverage of benefit and asks for the payment guaranteein advance to expensive examinations for all outpatients 7. Assists patient on insurance coverage related matters 8. Responds to and follows through on patient and insurance relatedinquiries 9. Conducts financial screening for all inpatients (Observation, DaySurgery, Admission) 10. Coordinates and answers inpatient inquiries 11. Coordinates on discharge process, prepares itemized interimstatement upondischarge 12. Maintains strictest confidentiality of patient information 13. Assists other office personnel in the performance of their duties asassigned and performs related work as required 14. Serve as liaison with the insurance company, hospital and client. 15. May also manage appeals for services denied. 16. Assists in training new employees of the Pre-certification team.
1. Minimum education- the completion of Junior College 2. Working experience in BJU or a similar health care organization or abusiness setting desired 3. Must be flexible to work third shifts 4. Additional education/experience may be substituted forexperience/education 5. Excellent oral and written English 6. Independent decision making 7. Professional telephone etiquette 8. Good time management skills and must be able to prioritize 9. Must be flexible to work third shifts 10. Basic computer skills 11. Must work well under pressure and be able to work on multiple taskssimultaneously. 12. Knowledge of medical terminology and insurance industry preferred 13. Knowledge of clinic charging, coding and insurance billingprocedures preferred (but trainable)