MedCloud RCM Competency : Eligibility/Authorization
To reduce AR delays and claim denials Medcloud crosschecks patient Medical Insurance Eligibility with the applicable Insurance Company which enables us to determine which elements of the treatment is covered by the patient’s policy
Additionally, we initiate and follow through with Preapprovals and Prior Authorizations to work towards collecting quicker payments from payers and a revenue increase.
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Roles and Responsibilities
Insurance Verification Specialist
The Insurance Verification Specialist’s primary responsibility is reviewing insurance benefits and requirements for patientsby contacting the appropriate insurance company for the purpose of identifying Patient Eligibility, obtaining Eligibility Term Dates, obtaining deductible information, co-payments and co-insurance amounts due, obtaining Authorization requirements and subsequently documenting all information in the patient’s account.
- Obtains Patients’ Medical Insurance Benefits
- Verifies and obtains any necessary Referral, Pre-Authorization, or Pre-Certification as required by the payer.
- Ensures accurate, complete, and timely data entry of patients’ Demographic, Financial, and Clinical Information into required system(s).
- Provides estimates of Patient Self-Pay Responsibility.
- Maintains regular communication and follow-up with Client Clinical Team, leadership team and Billing Department regarding Pending Referrals, Authorizations and/or potential issues.
- Disseminates supporting documentation in a timely manner to Clinicians, Company Leadership, and Billing Department.
- Completes all documentation, system entry, scanning and filing as required.
- Cross-trains in various office tasks and supports all office and customer service duties as needed.
- Maintains a deep understanding of all major insurance plans and products