Responsibilities:
Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.
Reviews recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
Analyzes orders authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.
Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients� insurance.
When necessary contacts agencies outside the hospital to obtain pertinent patient information and to coordinate clinic/treatment
programs.
Collaborates with various Brown University Health personnel to resolve billing issues authorization denials and insurance denials/write-offs.
Provides mature quality customer service to patients their families and/or their representatives.
Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments.
As assigned ensures staff is made aware of changes in hospital or third-party procedures; ensures appropriate training and adherence to approved policies and processes directly or through supervisory staff.
Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.
Performs other duties as assigned.
