This position will split time between Insurance Verifier and Cash Poster.
The Medical Insurance Verifier is responsible for ensuring the facility will be reimbursed for the procedures performed by calculating self-pay, costs, verifying eligibility and benefits, obtaining authorizations and comparing procedures scheduled against insurance contracts and approved ASC procedure listings.
The Cash Poster is responsible for maintaining the integrity of the payment denial and adjustment transactions posted in the patient accounting system. The poster will audit payments received against facility contracts, enter and post debit and credit transactions
- Verify that sufficient information is available for accurate verification and eligibility. This step may require direct contact with the physician office and/or the patient.
- Utilize the centers selected vendor for claims and eligibility and/or individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information.
- Enter the patient insurance information into patient accounting system ensuring the selection is the appropriate payer and associated financial class.
- Obtain authorizations from insurance companies/physician offices. Ensure complete and accurate information is entered into the patient accounting system and the procedure scheduled, date of service and facility name are on the authorization. Ensure the authorization has not expired.
- Calculate co-pay, and estimated co-insurance due from patients per the individual payer contract and plan as applicable.
- Be familiar with individual payer guidelines and the process of collecting over the counter payments/deductibles/co-pay/co-insurance. Knowledge of payer contracts including Medicare, Medicaid and other government contracts and guidelines and workmen’s compensation fee schedule.
- Contact the patient and communicate the center financial policy
- SCA’s goal for each patient’s Insurance Verification Rep is complete and accurate. The insurance verifier will document the findings in the patient account and will contact the patient with either estimated co-insurance, co-pay and or deductible amounts due on or before the date of service as applicable.
- In depth working knowledge of all facility contracts to ensure all claims are paid per contract with no lost revenue. Audits all payer explanation of benefits for accurate insurance claim adjudication.
- Post all insurance and patient payments line-by-line in the Patient Accounting System
- Balances all payments prior to posting and ensures the appropriate level of approval is obtained on all write offs and refunds
- Records deposit amounts into facility financial packet and completes bank remote deposits of any live checks received