Insurance Verifier - FT - Days - Pre-Access Services

DHR Health - US:TX:McAllen - Days

Summary:

POSITION SUMMARY:

Determines third party insurance eligibility, financial status, and eligibility for registration by reviewing insurance information.

POSITION EDUCATION/ QUALIFICATIONS:

• High school diploma or GED required.
• Experience in claims filing, hospital setting preferred.
• One (1) year billing experience required.
• Relevant education may substitute experience requirement.
• Good written and verbal communication skills required.
• Ability to read, write and speak English
• Ability to communicate clearly and concisely with all levels of nursing, administration, and physicians
• Prefer hospital experience
Secretarial experience is required

JOB KNOWLEDGE/EXPERIENCE:

• High degree of competency/experience in general.
• Requires good communication and organizational skills.
• Requires reasoning ability and good independent judgment.
• Requires working with frequent interruptions.
• Must project a professional image.
Must possess working knowledge of personal computers and software applications used in job.

Responsibilities:

POSITION RESPONSIBILITES:

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Determines hospital privileges of physician attending patient by checking the listing of active medical staff.
• Determines financial status and eligibility for registration by reviewing Insurance information.
• Obtains patient demographic information, type of insurance, diagnosis and procedure requested.
• Explains rates, charges, services when applicable, and hospital policy regarding payment of bills.
• Communicates information about scheduled case procedure to various departments and personnel involved.
• Obtains patient’s insurance information, including benefit information, policy number, group name, group number.
• Obtaining pre-certification approval when needed.
• Calling third party payer to obtain effective dates of coverage, billing addresses, existing condition clauses and network information.
• Confirms billing address, pre-existing conditions, in and out of network benefits and maximum coverage.
• Utilizes phone or on-line verification systems, i.e. TMHP, IVANS, FISS and Availity, etc for insurance eligibility and benefits.
• Ensures referral/pre-authorization requirements have been met.
• Obtains date of injury, compensable bodily injury, adjuster’s name, onset of illness and claim number for worker’s compensation.
• Verify and assign appropriate insurance plan code as needed.
• Document clearly and concisely all patient information on accounts through the patient accounting system (Account notes section, Aeos system, pre-cert screen).
• Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required.
• Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
• Ability to reference ICD-9 CM/ICD-10 CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure.
• Start Retro cases for patient’s accounts that do not have authorization before the exam was done.
• Call doctor’s offices to obtain clinical information to fax to the insurance office for the Retro cases.
• Obtain pre-authorizations for Radiology procedures for physicians that request it.
• Ensures that all accounts for the next day are verified.
Other duties as assigned.

Other information:

LINES OF REPSONSIBILITES:

(Chain-of-com mand)

1. Office Supervisor 2. Office Manager 3. Practice Administrator

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.