Insurance Verifier, Ambulatory Patient Access

Insurance Verifier, Ambulatory Patient Access - 20899

US:

TX:

Edinburg | Financial Services | Full Time

Posted 2 days ago

DHR Health - US:

TX:

Edinburg - Days

Summary:

Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.

Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

This position will determine insurance eligibility and financial status by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits, which include the effective dates of coverage, patient financial responsibility, referral and authorization requirements, in and out of network benefits and maximum coverage.

• High School Diploma/ GED is required
• Comprehensive understanding of insurance benefits, referral requirements, reimbursement and medical terminology
• Ability to work with geriatric patients in a high volume fast paced practice
• Computer skills required with knowledge of Microsoft Office suite, and the internet
• Excellent written and verbal communication skills required
• Bilingual – English/Spanish – preferred

• Minimum of 2 years of insurance verification/referral experience is preferred, physician office experience preferred
• Communicates clearly and concisely via phone and is able to work effectively with other employees, providers, patients and external parties
• Medical Terminology, ICD and CPT Codes, HCPCS code, knowledge preferred
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Requires reasoning ability, good independent judgment and organizational skills
• Requires working with frequent interruptions
• Must project a professional image

• Serves as a daily resource for all questions from providers, management and staff
• Appropriately monitors and verify benefits on all accounts requiring referrals and authorizations on a daily basis
• Assists billing staff with researching accounts with discrepancies in payments, rejections and/or denials to ensure appropriate payer reimbursement
• Handles calls and questions from patients, physicians, ins. carriers and ancillary providers with questions concerning referrals and authorizations
• Confirms billing address, in and out of network benefits and maximum coverage for services being provided
• Uses knowledge of ins. carrier requirements to give appropriate information to each carrier, ex. MCR vs. MCD when requesting benefit information.
• Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, effective date of coverage, and claim address
• Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier
• Reviews and confirms patient's deductibles, co-pays, and co-insurance on patients account
• Ability to identify the appropriate coordination of benefits for insurance carrier
• Utilizes phone and on-line verification systems, i.e. TMHP, Availity, Customer Kiosk and insurance carrier portals for eligibility, benefits and authorization submission
• Ensures referral/pre-authorization/pre-certification requirements have been met in a timely manner
• Verifies that the appropriate insurance carrier is assigned to the account and updates/corrects insurance information if applicable.
• Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for…