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Medical Insurance Specialist I
2022-09-01Organization
Shared Services Center - Sarasota
- Location SARASOTA, FL (Shared Services Center - Sarasota)Full Time
- Department Central Scheduling Hosp
- Field Finance and Accounting
Location SARASOTA, FL (Shared Services Center - Sarasota)
Department Central Scheduling Hosp
Field Finance and Accounting
Full Time
Job Description
The Shared Services Center - Sarasota provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers.
Responsible for providing professional, accurate and timely insurance verification, ensuring authorization requirements are met per payor guidelines and preregistration for scheduled outpatient services. Additional responsibilities include accurate and timely notification of admission or observation status according to payor guidelines for inpatient and observation services, and accurate and timely indexing of all incoming orders.
Essential Duties and Responsibilities
(List in order of importance or percentage of time spent on the particular responsibility – High to Low)
Verify insurance eligibility and benefits for scheduled services or service being provided |
Accurate calculation of patient’s estimated responsibility for scheduled services |
Determination of authorization/referral requirements according to payor guidelines |
Validation of all authorizations/referrals according to established guidelines |
Determine if scheduled service is medically necessary according to payor guidelines |
Adherence to all documentation standards |
Educate patients on insurance benefits and financial responsibility effectively |
Ability to perform all other duties as assigned or requested |