Perform pre-registration and insurance verification for inpatient and outpatient services.
Follow scripted benefits verification and pre-certification format in the EMR and document results.
Contact patients to confirm or obtain missing demographic information, quote/collect patient cost share, and provide appointment instructions.
Assign insurance plans accurately and perform electronic eligibility confirmation.
Complete Medicare Secondary Payor Questionnaire as applicable.
Calculate patient cost share and arrange payment or collection via phone.
Research patient visit history to ensure compliance with payor-specific rules (e.g., Medicare 72-hour rule).
Communicate with physicians and case managers to resolve authorization or referral issues.
Document benefit and authorization information in the standard EMR screens and notes as needed.
Implement system downtime procedures when necessary.
Practice and adhere to the organization’s Code of Conduct and Mission and Value Statement.

Insurance Verifier

Key skills