In this role, you will play a vital role in ensuring our patients receive the maximum benefit from their insurance plans or company contracts. You will be responsible for verifying coverage information, submitting medical records for pre-authorization and claim processing, and keeping patients informed throughout the process. Your expertise will streamline the claims process for both patients and the hospital.
Job Responsibilities
- Patient Advocate:
- Assist patients in utilizing their insurance benefits for treatment at MedPark Hospital.
- Clearly explain insurance coverage details and answer any related questions.
- Provide guidance on optimizing claims processing for faster approval.
- Coverage Verification:
- Meticulously review all patient charges to ensure accuracy.
- Verify patient benefit details through the provider portal.
- Pre-Authorization Specialist:
- Gather and prepare medical documentation for pre-authorization of surgeries or admissions.
- Electronically submit required documents to insurance companies via fax and email.
- Proactively follow-up on guarantee of payment letters through phone calls and emails.
- Coordinate with internal departments to ensure timely completion of all necessary reports and document requests.
- Clearly communicate coverage information to patients.
- Guarantee of Payment:
- Prepare and submit medical documentation for OPD (outpatient) and IPD (inpatient) visits to insurance companies.
- Maintain a diligent follow-up schedule (within 7 days for OPD and before discharge for IPD) to secure guarantee of payment letters.
- Communicate effectively with patients regarding their coverage status.