Insurance Verification Specialist - Ambulatory Access

DHR Health; Edinburg (TX); On-site; USD 34,000 - 43,000; Full time

Job summary

DHR Health in Edinburg, TX is seeking an Insurance Verifier for Ambulatory Patient Access. This full-time role verifies benefits, reviews eligibility and coordinates authorizations to support patient access and billing processes.

You will communicate with payers, patients and staff, handle referrals, and ensure accurate financial information while maintaining confidentiality in a fast-paced environment.

Qualifications

• High School Diploma/ GED 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.
• Confirms billing address, in and out of network benefits and maximum coverage for services being provided.
• Uses knowledge of ins. carrier requirements to give appropriate information to each carrier, ex. MCR vs. MCD when requesting benefit information.
• Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, effective date of coverage, and claim address
• Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier
• Reviews and confirms patient's deductibles, co-pays, and co-insurance on patients account
• Ability to identify the appropriate coordination of benefits for insurance carrier
• 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
• Verifies that the appropriate insurance carrier is assigned to the account and updates/corrects insurance information if applicable.
• 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
• Communicates information about scheduled case, procedure, referral, authorizations to office personnel involved, as needed
• Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
• Uses knowledge of procedures to review and coordinate the correct diagnosis with procedures for each patient referral received
• Receives faxed authorizations from insurance carriers and MD offices, hospitals and other specialists to ensure continuation of care to other services for clinic patients
• Calls with patient on the line to advice if the PCP on file is different than the PCP the patient is scheduled with, example HMO plans.
• Arranges for peer to peer reviews for insurance coverage/authorization as needed
• Provides medical records release of information for patients as needed
• Demonstrates proficiency of computer and practice software as required
• Ensures patient confidentiality requirements are met in accordance with policies and procedures
• Report any/all equipment failures to Supervisor and Administrator
• Other duties as assigned

Skills

Insurance verification

Bilingual English/Spanish

Medical terminology

Verbal communication

Numerical calculations

Education

High School Diploma/GED

Job description

DHR Health in Edinburg, TX is seeking an Insurance Verifier for Ambulatory Patient Access. This full-time role verifies benefits, reviews eligibility and coordinates authorizations to support patient access and billing processes.

You will communicate with payers, patients and staff, handle referrals, and ensure accurate financial information while maintaining confidentiality in a fast-paced environment.