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Insurance Verifier

WILSON COUNTY MEMORIAL HOSPITAL DISTRICT · CMMC South Campus - Floresville, TX 78114

External listingfull-time20 days ago

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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