Summary:
Determines and verifies insurance coverage and coordination of benefits from all sources.
Detailed responsibilities:
Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for scheduled procedures.
Enters patient insurance information into the patient record and documents insurance coverage of services to be provided.
Notifies patient of his/her financial responsibility for services to be provided. Notifies patients and practitioners of any services requested and/or referred that are not authorized by insurance.
Communicates with patients and practitioners regarding financial responsibility and insurance coverage issues.
Competencies and skills:
Essential:
STANDARDS OF BEHAVIOR: Acts in a manner that supports the standards of communication, respect, privacy, and teamwork by demonstrating a commitment to professional and ethical conduct.
CUSTOMER SERVICE: Demonstrates commitment to service excellence by promptly addressing internal/external customer issues/requests, resolving concerns while maintaining a professional image and behavior to build and enhance the patient/family/customer experience.
ACCOUNTABILITY: Accepts ownership of job roles and specific assignments/goals; works independently, takes responsibility for own actions; admits mistakes and judgment errors; and accepts constructive feedback. Connects personal work results to the accomplishment of team and organizational goals.
RESPONDING TO CHANGE: Accepts change and adapts in a positive and productive manner; handles unexpected situations and changes in direction calmly and with confidence. Views new assignments and job responsibilities as an opportunity for growth.
ACCURACY: Completes work assignments within established quality and/or quantity standards.
EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
PROBLEM SOLVING: Ability to identify, analyze and effectively solve problems.
TEAM WORK: Contributes to fullest potential to achieve team goals.
ORGANIZATION SKILLS: Organizes work to achieve maximum efficiency.
PRODUCTIVITY: The rate or volume of work that is achieved while complying with defined standards.
PATIENT AND FAMILY CENTERED CARE: “Provides Patient and Family Centered Care to patients, families, visitors and internal customers”
Education:
Essential:
High School Diploma or Equivalent
Credentials:
Other information:
Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Required to type 35 wpm.
Required Work Experience: None required.
Working conditions:
Essential:
Keyboard Entry 80.00%
Lifting or Carrying 0 – 25 lbs Non-Patient 60.00%
Pushing or Pulling 0 – 25 lbs Non-Patient 60.00%
Repetitive Movement Hand/Arm 80.00%
Sitting 80.00%
Standing 80.00%
Walking 80.00%
Audible Speech 80.00%
Hearing Acuity 80.00%
Depth Perception 80.00%
Seeing – Far 80.00%
Seeing – Near 80.00%
Computer Monitor 80.00%
Organizational Profile:
Memorial Healthcare System, consisting of 6 acute care hospitals, a nursing home, outpatient facilities, home health services and physician practices, provides quality, comprehensive care to the residents of the surrounding communities. We invite you to join one of the nation’s leading healthcare systems, recognized for use of advanced technology and clinical informatics.
Memorial Support Services provides a variety of business services to support our facilities. The main offices are located in Miramar with satellite offices located throughout our system.
Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.
To apply for this job please visit www.mhs.net.
