Ambulatory Insurance Verifier & Patient Access

DHR Health; Edinburg (TX); On-site; USD 22,000 - 30,000; Full time

Job summary

DHR Health in Edinburg, TX is seeking an Insurance Verifier, Ambulatory Patient Access. The role determines insurance eligibility and financial status by reviewing information via phone or online verification, contacting payers to obtain benefits including effective dates and patient responsibilities.

You will work with referrals and authorizations, verify in/out of network benefits, and support billing with resolving discrepancies.

Qualifications

• 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

Responsibilities

• 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
• Verifies that the appropriate insurance carrier is assigned to the account and updates/corrects insurance information if applicable
• 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
• Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
• Enter appropriate notes in the patient accounting system by documenting clearly and concisely all patient benefit information

Skills

Insurance benefits understanding

Geriatric patient care

MS Office

Communication skills

Bilingual English/Spanish

Education

High School Diploma/ GED

Tools

TMHP

Availity

Customer Kiosk

Job description

DHR Health in Edinburg, TX is seeking an Insurance Verifier, Ambulatory Patient Access. The role determines insurance eligibility and financial status by reviewing information via phone or online verification, contacting payers to obtain benefits including effective dates and patient responsibilities.

You will work with referrals and authorizations, verify in/out of network benefits, and support billing with resolving discrepancies.