Description
Verify patient insurance eligibility, benefits, and required authorizations to ensure coverage and accurate billing. Communicate patient financial responsibility, update insurance information in medical records, coordinate with patients, providers, and payers, and maintain compliance with payer policies and privacy regulations.
- • Verify patient insurance eligibility, benefits, and coverage limits prior to service.
- • Confirm network status, referral needs, and plan requirements for scheduled services.
- • Obtain and track prior authorizations and precertifications with payers.
- • Review orders and CPT/ICD codes for coverage and medical-necessity requirements.
- • Estimate patient responsibility, including copays, coinsurance, and deductibles.
- • Communicate cost estimates to patients and arrange pre-service payments as needed.
- • Update and maintain accurate insurance demographics and scanned cards in EMR/PMS.
- • Document verification details, contact notes, and authorization numbers in records.
- • Contact payers via phone, portals, or clearinghouses to resolve discrepancies.
- • Coordinate with clinicians, schedulers, and billing to align services with coverage.
- • Complete and submit authorization requests with required clinical documentation.
- • Monitor expiring authorizations and coverage changes; renew or resubmit as needed.
- • Address eligibility- or authorization-related denials; escalate or appeal when appropriate.
- • Answer patient and staff inquiries regarding benefits, coverage rules, and estimates.
- • Run and distribute daily eligibility and authorization reports for upcoming appointments.
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Healthcare & Human Services
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Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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Last reviewed: Jan 2026
