Claims Examiner

Insurance Representative

The Insurance Representative is responsible for verifying all patient demographics and patient insurance benefits in order to inform patients of their estimated liabilities. Ensuring that the hospital is reimbursed for services. General Responsibilities : Gathers accurate patient demographic and insurance information on Inpatient / Outpatient registration. Distributes appropriate information to all departments Monitors diagnostic tests ordered by physicians for Medical necessity according to government guidelines. Verifies patient's insurance coverage / benefits and documents information in the AS400. Notifies Supervisor of Self-pay patients and UR Department of Insurance coverage issues. Ensures the pre-certifications and authorizations are obtained by physician offices when required. Notifies appropriate departments if not obtained. Perform other duties as assigned according to departmental standards.