Insurance Coordinator - Cardiac Rehab

Job Description Summary

The Insurance Coordinator is responsible for the admission process and insurance verification for patient and referrals to the Outpatient Cardiac Rehabilitation department. Responsible for and ensures compliance with third party payer requirements and act as liaison between the department and the insurance company’s advocates for the patient to ensure appropriate receipt of benefits and coordination of cardiac rehabilitation services. The Insurance Coordinator role is responsible for the all of the functions of the intake and new referrals processes in the outpatient cardiac rehab dept. Utilizing the EPIC EMR, responsibilities include checking patients in, scheduling appointments, copayment collections, phone follow-ups with newly referred patients. Also responsible for performing the various steps of the admission process and insurance verification for patient and referrals for the outpatient cardiac rehab department. Assists with the process of insurance verification in compliance with third party payers. Supports the cardiac rehab team members (nurses, exercise physiologists, dietitian) with all front desk tasks that are needed for daily operations. Connects with the various MD provider groups who refer patients to cardiac rehab in obtaining MD orders, stress test results, office notes, procedure and operative report summaries. Demonstrates effective communication skills and proven organizational and interpersonal skills. Strong skills needed for phone follow-ups and interviewing prospective patients referred to the program. Knowledge of medical terminology and clinical knowledge, Demonstrated basic knowledge base and experience with third party reimbursement, and computer technology.

Job Description

Main Job Responsibilities:

 REQUESTING SERVICES/PROVIDING PROGRAM INFORMATION

Responds to incoming calls requesting services and information regarding
     programs offered for Cardiac Rehab Services, completing insurance intake
     information from patients, physicians and other sources.

Demonstrates ability to develop effective relationships with payer representative to facilitate coverage and problem resolution
·             Provides documentation for third party payer benefits in a timely manner
·             Understands coordination of benefits and acts as a liaison between patients and clinicians.
·             Demonstrates knowledge of payer requirements; initiates methods to maintain knowledge
·             Maintains communication with nurse manager to establish procedures to ensure payer requirements are met
·             Verifies and ensures accuracy of orders with regard to appropriateness for services, identification of a diagnosis, date and signature


PRE-AUTHORIZATION
Creates an accurate data base for all patient’s and verifies third party coverage.

   Demonstrates independence, proficiency and accuracy in obtaining referral information
·             consistently completes insurance tracking accurately and makes any updates in referral shell
·             consistently obtains pre-authorizations/certification for services per payer guidelines before initial date of service
·             Enters into the referral shell in EPIC and records patients medical record referral information as it is received
 

OBTAINING LETTERS OF MEDICAL NECESSITY
Work with patients referring MD if medical necessity is required before booking initial appointment for cardiac rehab services.
             

CARDIAC REAHB PROGRAM ENROLLMENT
Is responsible for the successful collection of all necessary documentation from patients, physicians, and other facilities for patients entering the Cardiac  Rehab program and provide clerical support to department as needed

   Provides consistent clerical support to Cardiac Rehab department as scheduled by Nurse Manager
·             Upon receipt of physician referral to the program, begins admission process by pre-registering patient, assuring appropriate testing/documents, EMR reports, and initiates patient chart in a timely manner
.             Mails all appropriate forms for patient’s to complete and return to enter Cardiac programs
·             Works with Cardiac Rehab Nurse Manager when concerns arise, or are behind in preparation/scheduling of patients into the programs
·             Assures that cardiology MD offices have program forms in their offices to give to patients at time of referral
 

CUSTOMER SERVICE/CHECK –IN
Greets and acknowledges all patients and visitors, both in office and on telephone, with professionalism and directs to appropriate services.

Proactively greets customers by name and with individualized interest
·             Follows through on messages to be sure to keep entire team informed of issues as needed
·             independently initiates service recovery process while keeping all team members informed as needed
 

PRE-REGISTRATION AND REGISTRATION
Completes pre-registrations and registrations with respect for patient privacy, and understands the impact of data accuracy on hospital operations.
·             Ensures complete collection of referral information, including accurate patient demographics per department standard, and referring physician contact information, correcting errors when needed
·             Ensures accurate registration of insurance information and communicates to patient in a confidential manner
·             Completes registration and data entry of admission by selecting correct MR number and account number, if not previously completed
·             Orients new patients to essential program guidelines and expectations (i.e. cancellation and no-show policy, co-pays)  to facilitate optimal participation and comfort in the program.
·             Informs patients of their rights and responsibilities, HIPAA and completes all documentation,
·             Demonstrates ability to determine acceptability of physician’s order with regard to clarity of diagnosis, appropriateness

SCHEDULING APPOINTMENTS
Schedules cardiac rehabilitation appointments in an efficient, coordinated, integrated manner to maximize optimal utilization of resources and patient access to services

Able to accurately and independently complete a full set of appointments.
·             Accurately cancels and reschedules when possible all cancelled appointments at time of message received
·             Communicates with all appropriate staff in a timely manner any conflicts or difficulty scheduling visits
 

CO-PAYMENT COLLECTION
Adheres to department standards for timely collection of co-payment, completing all documentation and delivery according to department standard

LONG TERM PROJECTS AND DAILY ASSIGNMENTS
Works independently to complete daily assignments by the end of the shift and long term assignments by deadline established

TECHNOLOGY:  Embraces technological solutions to work processes and practices. 
 

FULLTIME: 40 HOURS/WEEK

SCHEDULE: Mon-Friday 8AM-4:30PM

Minimum Education - Preferred

High School Diploma or GED preferred.

Minimum Work Experience

Two (2) years business office and health insurance verification and referral management experience preferred.
Previous health care environment experience of two (2) years preferred

Required additional Knowledge, and Abilities

Demonstrates effective communication skills and proven organizational and interpersonal skills.
Knowledge of medical terminology and clinical knowledge, Demonstrated knowledge base and experience with third party reimbursement, and EPIC EMR computer technology.