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Insurance Verifier - FT - Days

Company: DHR Health
Location: Brownsville
Posted on: June 6, 2021

Job Description:

POSITION SUMMARY:

This position will determine insurance eligibility, financial status and eligibility for registration by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage.


POSITION EDUCATION/QUALIFICATIONS
:

  • High School Diploma/ GED is required
  • Understand insurance benefits and medical terminology
  • Knowledge of Microsoft Office suite, working knowledge of Excel required
  • Excellent Customer Service
  • Good written and verbal communication skills required.
  • Ability to read, write and speak English required
  • Ability to communicate clearly and concisely with all levels of management
  • Previous healthcare experience (1-2 yrs.) is required, hospital experience preferred.


JOB KNOWLEDGE, SKILLS, AND EXPERIENCE
:

  • Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
  • Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
  • Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, Modifier knowledge
  • Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Requires reasoning ability, good independent judgment and organizational skills.
  • Requires working with frequent interruptions.
  • Must project a professional image.


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
  • Appropriately monitor and verify benefits all accounts on the daily schedule and pre-admission roster for the next days services.
  • Forwards a completed copy of schedule with applicable patient benefits to Admissions and financial counselors daily.
  • Confirms billing address, pre-existing conditions, in and out of network benefits and maximum coverage.
  • Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage.
  • Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctors order to insurance carrier for eligibility and coverage of procedure
  • Ability to determine timely filing deadline for all insurance carriers.
  • Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier and on patients account and ORM Schedule.
  • Ability to identify the appropriate coordination of benefits for insurance carrier.
  • Utilizes phone or on-line verification systems, i.e. TMHP, IVANS, FISS, and Availity, etc., for insurance eligibility and benefits.
  • Determines financial status and refers patient for financial screening as appropriate.
  • Ensures referral/pre-authorization/pre-certification requirements have been met.
  • Obtains pre-certification approval as needed.
  • Obtains date of injury, compensable bodily injury, adjusters name, onset of illness and claim number, for workers compensation claims.
  • Verify and assign appropriate insurance plan code, as needed
  • Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure.
  • Prepare short registration by obtaining patient demographic information, type of insurance, diagnosis and procedure requested as needed.
  • Enter appropriate mnemonic in the notes tab in patient accounting system.
  • Utilizes tickler, when requesting additional information from other co-workers or departments.
  • Communicates information about scheduled case procedure to various departments and personnel involved.
  • Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Document clearly and concisely all patient benefit information on accounts through the patient accounting system (Pre-cert screen, account notes section of Paragon and ORM schedule).
  • Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required.
  • Maintains a contact list for each physician office.
  • Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
  • Other duties as assigned.

LINES OF RESPONSIBILITES:

Supervisor, Manager, Director

Keywords: DHR Health, Brownsville , Insurance Verifier - FT - Days, Other , Brownsville, Texas

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