Premier Medical Resources is looking to hire a full-time Medical Insurance Verifier Team Lead. This person will verify insurance policy benefit information and obtain Authorization/Pre-certification, prior to the patient’s visit or scheduled admission, or immediately following admission.
About Premier Medical Resources
Premier Medical Resources, LLC is a healthcare management company, headquartered in NW Houston near the Jersey Village area. PMR provides services to a network of healthcare clinics and hospitals around Texas. These services include staffing, logistics, operations, human resources, billing, accounts receivable, legal, IT, scheduling, and more.
ESSENTIAL FUNCTIONS
- Verifies insurance eligibility by utilizing online websites and systems
- Verifies and generates prior authorizations and referrals
- Reviews EOBs/ERAs and ensures proper payments
- Appeals denied health insurance claims
- Responds to patient billing inquiries
- Reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding
- Reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges
- Effectively utilizes ICD 10, CPT, HPCPS, modifiers and/or other codes according to coding guidelines
- Communicates effectively with provider and/or all appropriate parties regarding missing information such as CPT, diagnoses codes, documents, operative reports, etc. in order to ensure proper coding
- Creates claims and transfer to third-party payers utilizing the correct forms
KNOWLEDGE, SKILLS, AND ABILITIES
- Knowledge with in and out of network insurances, Workers Compensation, insurance verification, patient responsibility, and process for prior authorization
- Knowledge of interpreting EOBs, posting payments, and adjusting accounts appropriately
- Familiarity with ICD-10 codes and procedures
- Working knowledge of medical jargon and anatomy
- Must be task-oriented and have organizational skills
- Strong attention to detail
- Ability to communicate professionally with outside parties
- Ability to adapt with flexibility
MINIMUM QUALIFICATIONS
- High School Diploma or equivalent (required)
- 1 year in medical office or facility setting (preferred)
- 2 or more years in insurance, billing, and/or coding experience (preferred)
BENEFITS
We are offering a comprehensive benefits package including:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Short and Long Term Disability Insurance
- Employee Assistance Program
- PTO + Holidays
Source: Indeed.com
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