To ensure the financial integrity of each patient account generated to maximize reimbursement, including meeting any and all contractual requirements of managed care companies, pre-certification and authorizations. To educate and communicate to patients and/or responsible parties of any financial obligations or insurance problems to streamline the process for patient arrival in a clinic.

Duties: All duties performed will be done accurately and in a timely manner.

1. Collects, verifies and enters demographics and insurance information into the system on new and established patient accounts as requested directly or indirectly by receipt of scheduled appointments.
2. Obtains insurance information necessary for various clinical services or procedures.
3. Verifies patient eligibility and benefit package information via phone or online resources.
4. Advises patients and clinical staff regarding patient’s financial responsibilities and explains co-payment collection, deductibles and the billing process based on the patients financial status classification (FSC)
5. Obtains needed information from PCP and HMO payers to initiate managed care authorizations/pre-certification allowing no more than 48 hours for completion.
6. Make appropriate notations in the system in regard to actions taken and insurance verification and authorizations.
7. Review scheduling reports to ensure all patients listed are worked prior to patient appointment date.
8. Work closely with all managers and/or designated person regarding issues with insurance.
9. Advice supervisor of any pending issues or possible issues.
10. Maintain strict confidentiality
11. Other duties as assigned


Education and Experience: Minimum High School Diploma Minimum two (2) years general office/customer relations work preferably in a medical center or large group practice. Data entry, telephone service experience and medical insurance knowledge required. An understanding of Medicare, HMO, PPO’s and a clear understanding of the difference between all benefit packages recommended. Bilingual preferred. Ability to complete efficient and accurate data entry at a computer terminal, typing at least 30 words per minute. Ability to operate standard office equipment: copier, printer, fax machine. Excellent interpersonal skills for interaction with patients, physicians and other clinical staff. Excellent communications skills – written and verbal. Attentive to detail with a propensity for completeness. Ability to acquire a working knowledge of a medical center or large group practice.

Work Environment: Clinic setting. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinic environment.

Physical Demands: Requires manual dexterity, sitting, standing, stooping reaching, kneeling crouching, bending, walking and lifting to 40 pounds. Close vision and ability to adjust focus and adequate hearing for extensive telephone work.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.