- Determine eligibility and benefits using online systems and phone communication.
- Accurately identify and assign payer plan codes in the electronic health record system.
- Verify medical necessity per CMS standards.
- Gather missing patient demographic or insurance information.
- Determine primary and secondary liability.
- Obtain pre-certifications and pre-authorizations.
- Communicate patient financial responsibility.
- Escalate complex cases and maintain HIPAA compliance.
Customer serviceEHRHIPAA