Summary

Provides information to patients and maintains good patient rapport. Obtains insurance pre-certifications and verifications and ensures reimbursement from patients or other responsible parties.

This position is located at St. Luke's Tower in the Texas Medical Center.

Job Duties

• Financially clears patients for upcoming services.
• Responds to and assists the physician with patient questions.
• Obtains benefits, creates estimates for patient out of pocket, and submits authorizations for services.
• Follows up on submitted authorizations, notates authorization in the appropriate area in Epic for all services.
• Contacts patients to collect out-of-pocket expenses.
• Contacts departments regarding missing clinical information if required by the insurance company.
• Contacts PCP offices to obtain referrals.
• Understands high-level specialty services authorizations.
• Updates referral statuses and collection efforts in Epic.
• Answers Insurance Verification Helpline and solves insurance issues for patients, physicians, and departments.
• Responds to specific account inquiries by management.
• Creates estimate letters that are electronically forwarded to patients to inform them of their financial responsibility.
• Provides and explains educational material to patients.
• Investigates insurance coverage and demographics.
• Researches claims denied for no authorization and performed retro authorizations.
• Answers phones and provides information to patients or takes detailed messages and routes them to the appropriate party.
• Reviews patient treatment & therapy plans along with other clinical documentation for authorization submission.
• Understands copay assistance, free drug, specialty pharmacy.
• May assist with other tasks as needed such as enrolling patients in copay programs and assisting with the daily appointment report.

Minimum Qualifications

• High school diploma or GED.
• Three years of relevant experience.

Preferred Qualifications

• EPIC experience.
• Infusion experience and general specialty services benefits and authorization experience.