Ambulatory Insurance Verifier & Patient Access

DHR Health; Edinburg (TX); On-site; USD 38,000 - 54,000; Full time

Job summary

DHR Health in Edinburg, TX is seeking an Insurance Verifier for Ambulatory Patient Access. You will determine eligibility and financial status by reviewing insurance information via phone or online verification, and contact payers for benefit details, coverage dates, and patient responsibility.

The role requires strong communication, computer skills, knowledge of insurance terms, and the ability to work in a fast-paced clinic. Bilingual English/Spanish preferred to assist diverse patient needs.

Qualifications

• Requires high school diploma or GED.
• Understanding of insurance benefits, referrals, reimbursement and medical terminology.
• Ability to work with geriatric patients in a fast-paced clinic.
• Strong computer skills including MS Office and internet.
• Excellent written and verbal communication; bilingual preferred.

Responsibilities

• Serves as daily resource for questions from providers, management and staff.
• Monitors and verifies benefits on accounts requiring referrals/authorizations daily.
• Assists billing with researching discrepancies to ensure proper payer reimbursement.
• Handles calls from patients, physicians, carriers, and providers about referrals/authorizations.
• Verifies billing address and in/out of network benefits for services.
• Uses carrier requirements to provide accurate information (e.g., MCR vs. MCD).
• Reviews and confirms patient insurance details and coverage dates.
• References ICD-9/ICD-10, CPT, HCPCS for referrals and procedures.
• Reviews patient deductibles, co-pays, and co-insurance.
• Coordinates benefits across insurance carriers.
• Uses online verification systems for eligibility and authorization submission.
• Ensures required referrals/pre-auths are completed timely.

Skills

Excellent written and verbal comms

Bilingual English/Spanish

Microsoft Office proficiency

Medical terminology

Teamwork/communication

Education

High School Diploma/GED

Tools

TMHP

Availity

Customer Kiosk

Insurance carrier portals

Job description

DHR Health in Edinburg, TX is seeking an Insurance Verifier for Ambulatory Patient Access. You will determine eligibility and financial status by reviewing insurance information via phone or online verification, and contact payers for benefit details, coverage dates, and patient responsibility.

The role requires strong communication, computer skills, knowledge of insurance terms, and the ability to work in a fast-paced clinic. Bilingual English/Spanish preferred to assist diverse patient needs.