Insurance Verifier, Outpatient Surgery

2 weeks ago


Houston, United States Advanced Diagnostics Healthcare System Full time

**OVERVIEW**

Advanced Diagnostics Healthcare System is an independent, physician-led and patient-centered organization of hospitals, clinics and diagnostic centers in Texas. We are entirely focused on bringing you advanced, comprehensive care and superior patient experience. As we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a collaborative manner.

**JOB SUMMARY**

The Incumbent will be responsible for obtaining insurance benefits, verification of eligibility status, and assisting with authorizations over the phone and online; collecting accurate demographics, accurate data entry; scheduling appointments over the phone; scanning electronic records, and performing any other duties necessary to provide efficient, timely services to the patients, their families and providers.

This position is required to have a strong understanding of insurance billing and the surgical preauthorization process. Out of network authorization experience is a plus. Applicant should have complete understanding of the claim process from verification, co-pays, deductibles, coding, gap and single case agreement authorizations and appeals.

**DUTIES AND RESPONSIBILITIES**
- 1+ year medical experience or medical insurance verification and pre-certification.
- Familiarity with online insurance verification of deductibles and co-insurance calculations
- Submits requests for insurance eligibility and prior authorizations for all required insurances based upon plan or insurance contract for all upcoming appointments.
- Creates complete and accurate pre-registration accounts and verification of insurance eligibility and benefits for all scheduled appointments.
- Determines patient co-payments and calculates co-insurance and deductibles.
- Enters insurance coverage (co-payments, deductibles, etc.) accurately into patient Electronic Medical Record (EMR).
- Assist front office with verification questions or concerns.
- Obtains authorizations for procedures that require approval, as well as following up on pending authorizations.
- Communicates insurance coverage with the patient and the staff.
- Resolves any coverage issues and update patient Electronic Medical Record (EMR).
- Investigates and verifies insurance coverage and eligibility for scheduled services.
- Financial clear office visits that may involve minor procedures for specialist services.
- Contacts external PCP offices to initiate and secure insurance PCP referral approvals for specialists.

**REQUIREMENTS**
- High school diploma or GED.
- Some College, Associate’s Degree or higher preferred.
- Medical office and insurance: 2 years (required)
- Insurance authorization: 3 years of relevant experience in a Clinic or an Acute Care setting. (preferred)
- Strong understanding of insurance billing and the surgical preauthorization.
- Familiarity with medical terminology, insurance verification, and managed care processes.
- Multi-Specialty insurance verification experience.
- EMR experience EPIC, Cerna, or similar

**EDUCATION**
- High school diploma or GED.
- Some College, Associate’s Degree or higher preferred.

**CERTIFICATION, LICENSURE**
- ** N/A**

**KNOWLEDGE SKILLS & ABILITIES**
- Knowledge with in and out of network insurances, insurance verification, patient responsibility, and process for prior authorization.
- Ability to stay focused in a fast-paced environment, manage time efficiently, and able to multitask.


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