Insurance Verification Clerk - Specialty General Surgery - Full Time

CHRISTUS Health - Longview, TX

Full-time

Longview, TX

Ambulatory Health Care Services

About the position

This position is responsible for performing insurance verification functions for both scheduled and unscheduled patients. The role involves contacting insurance companies and utilizing an electronic eligibility system to analyze eligibility information and estimate patients' financial responsibilities based on their insurance contracts. Additionally, the position includes pre-certifying patient visits with insurance companies and coordinating with Case Management for necessary clinical details.

Responsibilities

• Determines each patient's insurance eligibility and benefits by verifying with insurance companies, employers, or through the electronic system.
• Identifies priority accounts based on coverage, date of service, and expected service costs.
• Verifies insurance for scheduled and unscheduled patients.
• Obtains effective dates, correct mailing addresses, and pre-certification telephone numbers, documenting all information in the system.
• Documents unique coverage items, such as pre-existing conditions and limitations, with special attention to uninsured and credit risk accounts.
• Calculates deductible amounts and out-of-pocket expenses like co-insurance and co-payments.
• Obtains pre-certification for current visits from insurance companies and notifies Case Management if clinical information is needed.
• Contacts pre-certification companies to obtain pre-certification numbers for hospital visits.
• Documents pre-certification/reference numbers in the system.
• Obtains authorization for Medicaid patients when necessary.
• Refers accounts needing clinical information to the Case Management Department.
• Corrects financial classes and insurance plans in the system to ensure accuracy.
• Identifies and corrects incorrect insurance plans or financial classes in the system.
• Deletes incorrect or changed insurance plans from history in the system.
• Corrects Medicaid plans to reflect the appropriate plan.
• Documents information for accounts with terminated insurance and changes them to self-pay.

Requirements

• High School Diploma or equivalent years of experience required.
• 1 to 3 years of experience preferred.