Insurance Verifier- Oncology

DHR Health Clinics Edinburg, Texas


Position at Renaissance Medical Foundation


This position will determine insurance eligibility, financial status and eligibility for registration by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage.  



  • High School Diploma/ GED is preferred.
  • Good understanding of insurance benefits and medical terminology
  • Knowledge of Microsoft Office suite, working knowledge of Excel required
  • Excellent customer service and interpersonal skills
  • Good written and verbal communication skills are required.
  • Ability to read, write and speak English required
  • Ability to communicate clearly and concisely with all levels of management
  • Previous healthcare experience (2 yrs.) is required, physician or hospital experience preferred.



  • Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties
  • Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM.
  • Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred.
  • Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Requires reasoning ability, good independent judgment and organizational skills.
  • Requires working with frequent interruptions.
  • Must project a professional image.



  • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
  • Appropriately monitor and verify benefits for all accounts on the daily office visit schedule and pre-admission roster for the next day’s services.
  • Forwards a completed copy of schedule with applicable patient benefits to front desk staff for collection of applicable deductible and co-pay amounts.
  • Confirms billing address, pre-existing conditions, in and out of network benefits and maximum coverage.
  • Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage.
  • Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
  • Ability to determine timely filing deadline for all insurance carriers.
  • Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier
  • Ability to identify the appropriate coordination of benefits for insurance carrier.
  • Utilizes on-line or phone verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits.
  • Determines financial status and refers patient for financial screening as appropriate.
  • Ensures referral/pre-authorization/pre-certification requirements have been met.
  • Obtains pre-certification approval as needed.
  • Obtains date of injury, compensable bodily injury, adjuster’s name, onset of illness and claim number, for worker’s compensation claims, as needed.
  • Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure.
  • Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
  • Document clearly and concisely all patient benefit information on accounts through the computer system
  • Demonstrates proficiency of personal computers and Microsoft Office applications and office practice software as required.
  • Has appropriate follow up and contact with hospital or patient if necessary.
  • When working at the reception desk, checking patients both in and out of the practice properly documenting registration in the computer, as needed.
  • Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
  • Other duties as assigned.