Surgery Estimate Representative

Description

Responsibilities

• Responsible for identifying and collecting deductibles, co-insurance, and past due account balances.
• Explains financial requirements to the patient in response to patient questions on billing and insurance matters; refers questions regarding more complex insurance/benefits questions to Site Billing Specialist.
• Evaluates patient financial status and establishes payment plans based upon authority levels.
• Responsible for accurately completing and interpreting insurance verification and benefits. Notifies patients, family members, physicians and/or supervisors of network insurance coverage issues that may result in coverage reduction.
• Scans all patient surgery estimate information into the patient’s chart.
• Reviews with patients their estimated out of pocket responsibility for surgery.
• Maintains general knowledge of insurance plans accepted by LOS.
• Responsible for daily balancing of collections.
• Maintains strictest patient confidentiality.
  
  

The job holder must demonstrate current competencies for job position including a general understanding of insurance requirements.

Requirements

Qualifications and Requirements

• High school diploma or GED
• Understanding of insurance rules and regulations including eligibility and referral requirements. Able to verify eligibility of each payer, per patient according to defined parameters.
• Requires knowledge of insurance rules and regulations, medical terminology and computer scheduling systems. Must posses knowledge of insurance rules and regulations including eligibility and referral requirements. Able to verify eligibility of each payer, per patient according to defined parameters.
• Must be able to communicate effectively with physicians, patients and the public as well as be capable of establishing good working relationships with both internal and external customers.
• Skills in customer service.
• Skills in communicating effectively with providers, clinical staff and the public.
• Skill in establishing good working relationships with both internal and external customers.
  
  

* If a candidate does not possess the required knowledge, the candidate will be given benchmarks and assessed on a candidate-by-candidate basis. *