Pre-Cert/Benefits Analyst Internal

Job Summary:

Achieves high standard of billing to best meet Good Samaritan Hospital strategic goals. Ensures highest third party reimbursement for the benefit of the patient.

Must be certified by HBI---Certified patient financial services specialist

Essential Job Duties:

1. Makes outgoing calls to insurance companies; utilizes insurance websites for pre-certification, authorization verification, or member eligibilty when available.
2. Works with intake to ensure procedures scheduled matches authorization request.
3. Determines if client’s insurance is a part of the provider network for highest reimbursement possible.
4. Documents appropriately in-coming pre-authorizations from insurance companies/maintains monthly reports to obtain on-going authorizations for future services as needed for clients.
5. Communicates via telephone or written correspondence with providers and clinical staff to provide additional medical information.
6. Communicates via telephone or written correspondence with providers and clinical staff to provide additional medical information.
7. Reviews accounts receivables information and notifies Patient Accounts Manager of potential denial of payment issues.
8. Alerts clinical staff of services scheduled for which no authorization is in place.

Secondary Job Duties That May be Reassigned:

1. Gets and distributes incoming, outgoing and inter office mail.
2. Answers and directs phone calls.
3. Updates job knowledge by participating in educational opportunities.
4. Contributes to team effort by completing other duties as assigned.

Job Specifications:

• Education: Associate Degree in social work, nursing or business or related field.
• Experience: Knowledge of software applications and administrative and clerical procedures. Proficient in spelling, grammar, punctuation, and other language skills. Proficient in keyboarding, data entry and business writing.