Insurance Verifier - FT - Days
Company: DHR Health
Posted on: June 6, 2021
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.
- High School Diploma/ GED is required
- Understand insurance benefits and medical terminology
- Knowledge of Microsoft Office suite, working knowledge of Excel
- 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
- Previous healthcare experience (1-2 yrs.) is required, hospital
JOB KNOWLEDGE, SKILLS, AND EXPERIENCE:
- Communicates clearly and concisely and is able to work
effectively with other employees, patients and external
- Demonstrates proficiency in Microsoft Office applications, be
able to type at least 35 WPM, and good working knowledge of Excel
- Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code,
- Able to perform basic mathematical calculations, balance and
reconcile figures, punctuate properly and spell correctly.
- Requires reasoning ability, good independent judgment and
- Requires working with frequent interruptions.
- Must project a professional image.
- 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
- 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
- Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctors
order to insurance carrier for eligibility and coverage of
- Ability to determine timely filing deadline for all insurance
- Reviews and confirms patient's deductibles, co-pays, and
co-insurance with insurance carrier and on patients account and ORM
- 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
- 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
- Verify and assign appropriate insurance plan code, as
- Reviews physician order for appropriate patient status
(Inpatient/Outpatient) before verifying coverage for
- Prepare short registration by obtaining patient demographic
information, type of insurance, diagnosis and procedure requested
- Enter appropriate mnemonic in the notes tab in patient
- 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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