Insurance Verification Representative

Insurance Verifier-FT-DAYS-Ambulatory Patient AccessUS:TX:Edinburg | Financial Services | Full TimeDHR Health - US:TX:Edinburg - DaysSummary:Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time.Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.This position will determine insurance eligibility and financial status 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, patient financial responsibility, referral and authorization requirements, in and out of network benefits and maximum coverage.High School Diploma/ GED is requiredComprehensive understanding of insurance benefits, referral requirements, reimbursement and medical terminologyExcellent customer service skills, requiredAbility to work with geriatric patients in a high volume fast paced practiceComputer skills required with knowledge of Microsoft Office suite, and the internetExcellent written and verbal communication skills requiredBilingual – English/Spanish – preferredMinimum of 2 years of insurance verification/referral experience is preferred, physician office experience preferredCommunicates clearly and concisely via phone and is able to work effectively with other employees, providers, patients and external partiesMedical Terminology, ICD and CPT Codes, HCPCS code, knowledge preferredAble to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctlyRequires reasoning ability, good independent judgment and organizational skillsRequires working with frequent interruptionsMust project a professional imageServes as a daily resource for all questions from providers, management and staffAppropriately monitors and verify benefits on all accounts requiring referrals and authorizations on a daily basisAssists billing staff with researching accounts with discrepancies in payments, rejections and/or denials to ensure appropriate payer reimbursementHandles calls and questions from patients, physicians, ins. carriers and ancillary providers with questions concerning referrals and authorizationsConfirms billing address, in and out of network benefits and maximum coverage for services being providedUses 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 addressAbility to reference ICD-9-CM/ ICD-10-CM, CPT from doctor's order to insurance carrierReviews and confirms patient's deductibles, co-pays, and co-insurance on patients accountAbility to identify the appropriate coordination of benefits for insurance carrierUtilizes phone and on-line verification systems, i.e. TMHP, Availity, Customer Kiosk and insurance carrier portals for eligibility, benefits and authorization submissionEnsures referral/pre-authorization/pre-certification requirements have been met in a timely mannerVerifies 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 procedureEnter appropriate notes in the patient accounting system by documenting clearly and concisely all patient benefit informationCommunicates information about scheduled case, procedure, referral, authorizations to office personnel involved, as neededAccurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctlyUses knowledge of procedures to review and coordinate the correct diagnosis with procedures for each patient referral receivedReceives faxed authorizations from insurance carriers and MD offices, hospitals and other specialists to ensure continuation of care to other services for clinic patientsCalls 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 neededProvides medical records release of information for patients as neededDemonstrates proficiency of computer and practice software as requiredEnsures patient confidentiality requirements are met in accordance with policies and proceduresReport any/all equipment failures to Supervisor and AdministratorOther duties as assignedLines of Responsibilities:1. Director Ambulatory Patient Access 2. VP of Revenue Cycle 3. Chief Ambulatory OfficerProvide 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.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.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. - Yes - Kneeling - YesMust be able to assist other employees with lifting more than 20 lbs. - Yes - Walking - YesLight/moderate carrying up to 20 lbs. - Yes - Standing/Squatting - YesStraight pulling - Yes - Sitting - YesPulling hand over hand - Yes - Pushing - YesRepeated bending - Yes - Stooping/Bending - YesReaching above shoulder - Yes - Climbing Stairs - YesSimple grasping - Yes - Climbing Ladders - NoDual simultaneous grasping - Yes - Depth Perceptions needed - YesAbility to see - Yes - Identify Colors - YesOperating office equipment - Yes - Twisting - YesOperating mechanical equipment - Yes - Crawling - NoAbility to read and write - Yes - Ability to Count - YesAbility to hear verbal communication without aid - Yes - Operating Personal Vehicle - YesAbility to comprehend written/verbal communication - Yes - Other: Ability to deal with stress - YesOSHA Category - IIIB. 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.D. Aptitudes : HIGH 1 2 3 4 5 6 LOWIntelligence: General learning ability: The ability to "catch on" or understand instructions and underlying principles. Ability to reason and make judgments. 3Verbal: 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. 3Numerical: Ability to perform arithmetic operations quickly and accurately. 2Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to "visualize" objects or two