ESSENTIAL DUTIES AND RESPONSIBILITIES
The responsibilities listed here represent the majority of the role but are not all-inclusive; other duties may be assigned.

• Verify insurance eligibility, benefits, network status, patient financial responsibility, and payer requirements across applicable commercial, Medicare, Medicaid, workers' compensation, and other coverage types for scheduled surgeries, procedures, diagnostic imaging, and durable medical equipment.
• Obtain and manage prior authorizations, precertifications, and referrals, including submission of required clinical documentation and follow-up through final determination.
• Confirm authorization details align with scheduled services and coordinate updates when procedure codes, dates of service, facilities, or treatment plans change.
• Coordinate authorization denials, reconsiderations, appeals, and peer-to-peer reviews with providers and payers as needed.
• Prepare and communicate estimates of patient financial responsibility, explain insurance benefits and coverage requirements, and address patient questions in a clear and professional manner.
• Collect applicable pre-service patient responsibility, obtain required financial acknowledgments, and coordinate payment arrangements, Good Faith Estimates, or available financial resources in accordance with practice procedures.
• Communicate financial clearance and authorization status with patients, providers, clinical staff, surgery scheduling, facilities, and other stakeholders to support timely care.
• Maintain complete and accurate documentation in applicable systems and partner with billing and revenue cycle resources to resolve authorization-related issues and denials.
• Support patient check-in and check-out activities and other clinic operations as needed.

QUALIFICATIONS

Knowledge, Skills, Abilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

• Working knowledge of medical insurance eligibility, benefits, prior authorization, referral, and precertification processes, including commercial and government payer requirements.
• Working knowledge of medical terminology and CPT, ICD-10, and HCPCS coding sufficient to support benefit verification and authorization activities.
• Ability to interpret payer requirements and communicate insurance coverage and patient financial responsibility clearly and professionally.
• Strong organization, problem-solving, follow-through, and attention to detail, with the ability to manage multiple cases and deadlines in a fast-paced clinic environment.
• Proficiency with electronic health records, practice management systems, payer portals, and standard office applications.

Education / Experience:  

Required:

• High school diploma or GED equivalent
• Minimum two (2) years of experience in medical insurance verification, prior authorizations, patient financial clearance, or related medical office or revenue cycle function
• Experience working with commercial and government payers and using payer portals for eligibility, benefits, and authorization activities

Preferred:

• Experience supporting surgical or specialty medical services, preferable general surgery
• Experience with authorization denials, appeals, and peer-to-peer coordination
• Familiarity with Epic and/or eClinicalWorks (eCW)
• Experience utilizing electronic medical record (EMR) systems.
• Medical billing, coding, or revenue cycle certification such as CPC, CPB, CRCS, or similar.
• Bilingual English/Spanish

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms.
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to remaining seated for periods of time to perform computer-based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This position operates in a professional office setting where the noise level is typically low.
• 2710 Swiss Avenue, Dallas, TX 75204
• Core Hours: Monday - Friday 9:00am - 5:00pm

ADA & Reasonable Accommodation Statement:

IES is committed to providing equal employment opportunities to qualified individuals with disabilities. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. If you require accommodation during the application or employment process, please contact [email protected].