Insurance Verifier, Pre-Access Services

DHR Health; McAllen (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

DHR Health in McAllen, TX is seeking an Insurance Verifier for Pre-Access Services. The role reviews insurance information to determine eligibility for registration and financial status, supporting accurate patient admissions and billing processes.

Qualifications include a high school diploma or GED, 1 year billing experience, and strong communication skills. The position emphasizes HIPAA compliance and proficient use of verification systems.

Qualifications

• High school diploma or GED required.
• 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.
• Determines hospital privileges by checking active medical staff listings.
• Determines financial status and eligibility for registration by reviewing insurance information.
• Obtains patient demographic and insurance information, diagnoses and procedures.
• Explains rates and hospital policy regarding payment of bills.
• Communicates information about scheduled procedures to departments and staff.
• Obtains insurance details including benefit information, policy and group numbers.
• Obtains pre-certification when needed and contacts third-party payers for coverage dates and network info.
• Verifies insurance eligibility and benefits using verification systems.
• Ensures adherence to HIPAA/PHI confidentiality and privacy requirements.
• Documents patient information clearly in accounting systems.
• Performs other duties as assigned.

Skills

English proficiency

Communication skills

PC/software proficiency

Billing experience

Education

High school diploma or GED

Tools

TMHP

IVANS

FISS

Availity

Job description

Insurance Verifier, Pre-Access Services - 21062

Posted 4 days ago

Description

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 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 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-com mand)

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.