Insurance Eligibility & Verification Specialist

DHR Health; McAllen, Northern (TX, KY); Hybrid; USD 38,000 - 56,000; Full time

Job summary

DHR Health in McAllen, TX is seeking an Insurance Verifier in Pre-Access Services. This role determines insurance eligibility and financial status for patient registration, obtaining demographic/insurance details and coordinating pre-authorization when needed.

Ideal candidates will have a high school diploma, one year billing experience, and strong English communication skills. Hospital experience and secretarial duties are preferred and encouraged in a patient-centered environment.

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.
• 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 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.
• Demonstrates proficiency of personal computers and Microsoft Office applications.
• Ensures patient confidentiality per HIPAA/PHI policies.
• Ability to reference ICD-9/ICD-10, CPT for eligibility and coverage.
• Start Retro cases for accounts without authorization before exam.
• Call doctor’s offices to obtain clinical information for Retro cases.
• Obtain pre-authorizations for Radiology procedures.
• Ensure that all accounts for the next day are verified.
• Other duties as assigned.

Skills

Communication

English proficiency

Microsoft Office

Hospital billing software

Education

High school diploma or GED

Tools

Microsoft Office

Hospital billing software

Job description

DHR Health in McAllen, TX is seeking an Insurance Verifier in Pre-Access Services. This role determines insurance eligibility and financial status for patient registration, obtaining demographic/insurance details and coordinating pre-authorization when needed.

Ideal candidates will have a high school diploma, one year billing experience, and strong English communication skills. Hospital experience and secretarial duties are preferred and encouraged in a patient-centered environment.