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Insurance Verifier - FT - Days

Company: Doctors Hospital at Renaissance
Location: Edinburg
Posted on: June 13, 2021

Job Description:

Description Position at DHR Health Job Description: Insurance Verifier Formulated: 5/21/2019Department: RadiologyReviewed by Senior Human Resources Business Partner: (Date Reviewed)Reports To: Practice Administrator Approved by Director of Human Resources: (Date Approved) EMPLOYEE'S FULL NAME: ________________________ FLSA STATUS: Exempt Non-Exempt MISSION STATEMENT: Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time. VISION: 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. 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. Relevant education may substitute experience requirement. Good written and verbal communication skills required. Ability to read, write and speak EnglishAbility to communicate clearly and concisely with all levels of nursing, administration, and physiciansPrefer hospital experienceSecretarial 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 practicesDetermines 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. LINES OF REPSONSIBILITES: Office Supervisor 2. Office Manager3. Practice Administrator Assistant Director of Radiology 5. Director of Radiology 7. 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: Compassion, Accountability, Respect, Excellence through Knowledge and Safety & Social Conscience. 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. YesKneelingYesMust be able to assist other employees with lifting more than 20 lbs.YesWalkingYesLight/moderate carrying up to 20 lbs.YesStanding/SquattingYesStraight pullingYesSittingYesPulling hand over handYesPushingYesRepeated bendingYesStooping/BendingYesReaching above shoulderYesClimbing StairsYesSimple graspingYesClimbing LaddersNoDual simultaneous graspingYesDepth Perceptions neededYesAbility to seeYesIdentify ColorsYesOperating office equipmentYesTwistingYesOperating mechanical equipmentYesCrawlingNoAbility to read and writeYesAbility to CountYesAbility to hear verbal communication without aidYesOperating Personal VehicleYesAbility to comprehend written/verbal communicationYesOther: Ability to deal with stressYesOSHA CategoryIIIB.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:HIGH123456LOW 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:____________________ Transfer/Hire Date Effective: ________________________. DISCLAIMER The above statements are intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. DHR leadership reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.

Keywords: Doctors Hospital at Renaissance, Edinburg , Insurance Verifier - FT - Days, Other , Edinburg, Texas

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