Insurance Eligibility Specialist (Pre-Access)

DHR Health; McAllen (TX); On-site; USD 32,000 - 52,000; Full time

Job summary

DHR Health in McAllen, TX seeks an Insurance Verifier in Pre-Access Services to determine insurance eligibility, financial status and registration readiness by reviewing payer information.

You will obtain patient demographics and insurance details, obtain pre-certifications when needed, and communicate with doctors, nursing staff and billing to ensure accurate, timely enrollment and billing.

Qualifications

• High school diploma or GED required.
• Experience in claims filing, hospital setting preferred.
• One year billing experience required.
• 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

Responsibilities

• 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.

Skills

Communication skills

English language

Secretarial experience

Education

High school diploma or GED

Tools

TMHP

IVANS

FISS

Availity

Microsoft Office

Job description

DHR Health in McAllen, TX seeks an Insurance Verifier in Pre-Access Services to determine insurance eligibility, financial status and registration readiness by reviewing payer information.

You will obtain patient demographics and insurance details, obtain pre-certifications when needed, and communicate with doctors, nursing staff and billing to ensure accurate, timely enrollment and billing.