Insurance Verifier- FT- Days- Radiology Admissions

DHR Health; Edinburg (TX); On-site; USD 38,000 - 48,000; Full time

Job summary

DHR Health in Edinburg, TX seeks an Insurance Verifier to determine third-party insurance eligibility, financial status and registration suitability by reviewing insurance information. The role supports Radiology Admissions on a full-time daytime schedule.

The candidate should have a high school diploma or GED, at least one year of billing experience, and strong written and verbal English communication skills. Hospital experience and secretarial skills are preferred.

Qualifications

• High school diploma or GED required.
• One (1) year billing experience required.
• Experience in claims filing or hospital setting preferred.
• Good written and verbal communication skills required.
• Ability to read, write and speak English.

Responsibilities

• Promotes the facility mission, vision and values in services and practices.
• Determines hospital privileges of physician by checking active staff.
• Determines financial status and eligibility for registration by reviewing insurance information.
• Obtains patient demographic information, insurance type, diagnosis and procedure requested.
• Explains rates, charges, services and hospital policy regarding payment of bills.
• Communicates information about scheduled procedures to departments and staff.
• Obtains patient’s insurance details including benefit information, policy number and group.
• Obtains pre-certification when needed.
• Contact third party payers to verify coverage dates and network information.
• Ensures referral/pre-authorization requirements are met.
• Verifies and assigns insurance plan codes as needed.
• Documents patient information in accounting systems clearly and concisely.

Skills

Communication skills

English proficiency

Billing experience

Claims filing

Hospital experience

Education

High school diploma or GED

Tools

Microsoft Office

Job description

Insurance Verifier- FT- Days- Radiology Admissions - 21973

US:TX:Edinburg | PATIENT CARE SUPPORT | Full Time

Posted 2 days ago

Description

DHR Health - US:TX:Edinburg - Days

Summary:

POSITION SUMMARY

Determines third party insurance eligibility, financial status, and eligibility for registration by reviewing insurance information.

POSITION EDUCATION/ QUALIFICATIONS

• High school diploma or GED required.
• Experience in claims filing, hospital setting preferred.
• One (1) 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

JOB KNOWLEDGE/EXPERIENCE

• High degree of competency/experience in general.
• Requires good communication and organizational skills.
• Requires reasoning ability and good independent judgment.
• Requires working with frequent interruptions.
• Must project a professional image.
• Must possess working knowledge of personal computers and software applications used in job.

POSITION RESPONSIBILITES

• 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.

Other information:

LINES OF REPSONSIBILITES

(Chain-of-command)

4. Director of Radiology - 6. Vice-President of Imaging Services

CUSTOMER SERVICE

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA)

A. Essential Duties: Indicated by bold print within performance standards, preceding individual numbered criteria.

The following table provides physical requirements that will be associated with, but not limited to, this position:

• Light/moderate lifting up to 20 lbs, from the floor to shoulder height.
• Must be able to assist other employees with lifting more than 20 lbs.
• Light/moderate carrying up to 20 lbs.
• Pulling hand over hand
• Pushing
• Repeated bending
• Stooping/Bending
• Reaching above shoulder
• Climbing Stairs
• Climbing Ladders
• Dual simultaneous grasping
• Depth Perceptions needed
• Ability to see
• Identify Colors
• Operating office equipment
• Operating mechanical equipment
• Ability to read and write
• Ability to Count
• Ability to hear verbal communication without aid
• Operating Personal Vehicle
• Ability to comprehend written/verbal communication
• Other: Ability to deal with stress

B. Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3

Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively. To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3

Numerical: Ability to perform arithmetic operations quickly and accurately. 2

Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2

Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3

Clerical Perception: Ability to receive pertinent details and verbal or tabular material. To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2

Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3

Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3

Manual Dexterity: Ability to move hands easily and skillfully. To work with hands in placing and turning motions. 3

Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3

Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3

I have read and reviewed my job description with my supervisor or designee and I understand the job I am expected to perform.

If applicable __________ certification will be completed within _________ time frame of hire/transfer date.

Employee Signature: ________________________________ Date: ____________________