MONICA NARVAEZ

Responsible for confirming a patient's insurance coverage by contacting insurance companies, verifying details of their plan, and informing both the patient and healthcare providers about their eligibility, copayments, deductibles, and any necessary authorizations required before receiving medical services; essentially ensuring accurate billing by verifying patient insurance information prior to treatment.

Patient information gathering: Collecting and updating patient insurance details, including policy numbers, group numbers, effective dates, and primary/secondary coverage.

Insurance company contact: Calling insurance companies to verify eligibility, benefits, and coverage limitations for specific procedures. Benefit verification:

Checking for copayments, deductibles, out-of-pocket maximums, and any pre-authorization requirements.

Patient communication: Explaining insurance coverage details to patients, including potential costs, and any necessary steps to take before receiving care.

Prior authorization requests: Initiating prior authorization requests for prescriptions, utilizing online portals and paper forms, as required by the plan. Documentation: Accurately documenting patient insurance information and verification results in electronic medical records.

Verifying patient insurance coverage and benefits: Checking eligibility, deductibles, copayments, and plan specifics to determine if a service is covered. Submitting prior authorization requests: Completing necessary paperwork, and electronically submitting requests to insurance companies with accurate medical codes and supporting documentation. Collecting clinical information: Gathering medical records, lab results, and other relevant patient data to support the prior authorization request. Communicating with insurance companies: Following up on pending requests. Patient and provider interaction: Informing patients and providers about authorization status, potential coverage issues, and required documentation. Maintaining accurate records: Tracking the status of prior authorization requests within the electronic health record system. Staying updated on insurance policies: Keeping abreast of changing coverage guidelines and payer requirements.

Medical coding knowledge: Understanding of ICD-10, CPT, and HCPCS codes for accurate billing and authorization. Insurance plan comprehension: Familiarity with different insurance policies, benefit structures, and prior authorization processes. Strong communication skills: Effectively communicating with healthcare providers, patients, and insurance companies.

Patient registration: Gathering patient demographic information, including contact details, insurance information, and medical history, to accurately register new and returning patients.
Insurance verification: Checking patient insurance eligibility, benefits, and coverage details with insurance companies to confirm billing accuracy.
Pre-authorization: Obtaining pre-authorization for specific procedures or treatments, when required by insurance plans.
Demographic data collection: Ensuring patient information is accurate and up-to-date in the electronic health record (EHR) system.
Prepared and posted weekly payments to vendors and suppliers.

Executed account updates and noted account information in company data systems.

Collected, posted and managed patient account payments.

Generated and distributed month-end statements for customers and resolved related concerns.

Charged expenses to accounts and cost centers by analyzing invoice and expense reports.