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WC
Insurance Verifier
WILSON COUNTY MEMORIAL HOSPITAL DISTRICT · CMMC South Campus - Floresville, TX 78114
About The Role
## Description
**Summary** Works directly with clinics to identify and secure payer referral requirements for maximum reimbursement
**Essential Duties and Responsibilities** include the following. Other duties may be assigned.
- Work requests from a queue or email communication from clinic staff or other source
- Confirm validity of any referrals already on file
- Submit request for needed referrals to appropriate authority or PCP
- Follow up to secure authorization prior to patient appointment to ensure reimbursement
- Provide requested clinical information to PCP to support referral
- Advise clinic staff of any anticipated delays for authorization
- Secure referrals and enter them in the patient’s electronic record
**Education and/or Experience**
- Strong, working knowledge of insurance payers to include government, commercial and managed care products
- Ability to establish a good rapport with outside providers and third party payers
- Resourceful, steadfast attitude to make sure that patient needs are met timely
- Comfortable with navigating through the payer websites to secure appropriate benefits and authorization requirements
- Excellent verbal and oral communication skills
- Excellent customer service skills are expected with internal and external customers
**Other Qualifications:**
- Must be able to multitask and demonstrate excellent organizational skills
- Understanding of insurance contracts and networks essential
- Extensive coding and medical terminology preferred
- Computer literate, knowledge of, or ability to learn multiple clinic/hospital software required.
## Qualifications
**Education and/or Experience**
- Strong, working knowledge of insurance payers to include government, commercial and managed care products
- Ability to establish a good rapport with outside providers and third party payers
- Resourceful, steadfast attitude to make sure that patient needs are met timely
- Comfortable with navigating through the payer websites to secure appropriate benefits and authorization requirements
- Excellent verbal and oral communication skills
- Excellent customer service skills are expected with internal and external customers
**Other Qualifications:**
- Must be able to multitask and demonstrate excellent organizational skills
- Understanding of insurance contracts and networks essential
- Extensive coding and medical terminology preferred
- Computer literate, knowledge of, or ability to learn multiple clinic/hospital software required.
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