Toni Mifflin

• Focuses on insurance accounts identified as high risk by the department.

• Notifies insurance company of services being rendered and obtains authorization if applicable; ensures notification, authorization and verification is completed for each account. • Completes and obtains insurance information and referrals; verifies policy information and obtains detailed benefit information; codes work list according to departmental guidelines.

• Updates and edits coverage information on non-scheduled or pre-admitted patients.

• Assists in identifying problems; assures insurance information and appropriate referrals have been completely and accurately obtained.

• Serves as a resource for co-workers and staff.

• Provides customer service in person by phone or email; assists customers, patients, families, providers, and staff with insurance questions or escalations.

• May work in conjunction with hospital departments to solve intradepartmental issues.

• Assists on special projects as assigned by the Supervisor.

• Provided assistance in training new employees on processes and procedures.
• Provided leadership and guidance to team members, ensuring that tasks were completed on time and to a high standard.
• Motivated staff through positive reinforcement techniques.
• Delegated daily tasks to team members to optimize group productivity.

• Verified patient eligibility and benefits for insurance coverage.
• Processed incoming requests, inquiries, and authorizations from health care providers.
• Followed up on pending cases with appropriate parties as needed.
• Entered all pertinent data into computer systems accurately and efficiently.
• Retained strong medical terminology understanding in effort to better comprehend procedures.
• Ensured compliance with departmental standards and performance expectations.
• Researched insurance coverage details for patients to determine authorization requirements.
• Created, tracked and maintained accurate records of all authorization requests.
• Advised medical staff on the status of authorization requests.
• Provided customer service support to patients regarding their authorization inquiries.

• Scheduled follow up appointments for patients via phone and in person.
• Answered phones, responded to inquiries, and directed calls appropriately.
• Entered patient demographic data into the electronic medical record system.
• Verified insurance coverage for scheduled appointments.
• Completed and safeguarded medical records, securing patient information to maintain confidentiality.