DHR Health -

US:

TX:

McAllen -

Days Summary:

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 English Ability to communicate clearly and concisely with all levels of nursing, administration, and physicians Prefer hospital experience

Secretarial 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.

Responsibilities:

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 practices Determines 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.

Other information:

LINES OF REPSONSIBILITES

(Chain-of-com mand) 1. Office Supervisor 2. Office Manager 3. Practice Administrator

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: Commitment, Accountability, Respect, Excellence and Service.