[Hiring] Insurance & Pre-Registration Representative @Prisma Health

Role Description

This role involves verifying insurance coverage and patient responsibility, ensuring accurate documentation and communication within the healthcare system.

• Verifies insurance coverage/benefits utilizing online eligibility, websites, or telephone inquiries to the insurance administrator and/or third-party payor.
• Documents insurance verification accurately and completely in the EPIC patient billing system.
• Ensures insurance priorities are correct based on third-party requirements/COB.
• Identifies current patient responsibility using insurance eligibility and benefit responses.
• Documents patient responsibility as required according to Departmental Guidelines.
• Initiates, obtains, and documents pre-certifications/prior authorizations as required according to Departmental Guidelines.
• Communicates new insurance system issues to appropriate personnel for review/correction.
• Manually corrects/updates current identified insurance issues according to departmental guidelines.
• Performs other duties as assigned.

Qualifications

• High School diploma or equivalent OR post-high school diploma/highest degree earned
• Two (2) years billing, bookkeeping, or accounting experience

Requirements

• Maintains up-to-date knowledge regarding current insurances, including plans that run through the system and appropriate ways to fix errors.
• Maintains knowledge of current managed care contracts and utilizes correct network or out-of-network status for each insurance.

Company Description

Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.