Careers At HGS

Insurance, Benefits and Pre-Authorization Verification Representative

Job Code : HGS/316
EL PASO | TX Permanent

Job Description

Obtain prior authorization, check eligibility and benefits for specific services by accessing payer websites or by telephone to payers and physicians, then to enter the prior authorization number into client and/or HGS billing system(s) with high levels of accuracy.  Follow established procedures and maintain quality levels set by the client.



Principal Duties and Responsibilities:


       Access Payer data bases through websites, interfaces, or telephone contact to verify the patient’s eligibility for the dates of service, to also verify that the policy has benefits that cover the care being planned, and to obtain prior authorization numbers for Government and Non-Government payers.

       Input verified data into the Client and HGS billing systems with high levels of accuracy.

       Follow work place rules such as attendance, break and lunches, and quality measures.

       Demonstrate professional behavior and respect toward fellow team members, team leaders, management and overall organization.



The above statements are intended to indicate the general nature and level of work being performed by employees within this classification.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job.  Employees in this job may perform other duties as assigned.  In addition to the above, all HGS employees are expected to:

* Promote teamwork and cooperative effort.  * Help train and give guidance to other HGS employees.  * Maintain a clean, safe, and unobstructed work area, and practice good safety habits.  * Provide internal and external customers with the highest quality service.


Minimum jOB Requirements: (Education, Experience, Skills)


·         Atleast 6 months of experience in initiating/ getting prior authorization (experience in doctor’s offices, free-standing laboratories and radiology settings, or hospital is preferred).

·         High school diploma or general equivalency diploma mandatory.

·         Ability to work in fast-paced environment with high accuracy

·         Ability to navigate through different insurance company and healthcare computer systems

·         Able to communicate orally and in writing in fluent English

·         Ability to research documents and find information

·         Must be flexible with the ability to adapt to changes quickly and to think conceptually







Customer Orientation

Agent understands the impact of individual performance as it relates to the client program and to meeting/improving targets; understands the client needs and expectations; responds to requests effectively and on time; refers complex questions to a higher decision making level; meets customer needs in a respectful, helpful and responsive manner; works with the team to meet objectives; is open to change and new information.

Communication Skills

Presents appropriate information in a clear and concise manner, both orally and written; able to establish two-way communication with Team Leaders.

Work Ethic

Ability to direct oneself towards meeting one’s daily, weekly and monthly goals; understands goals and works towards achieving them; asks for clarification regarding expectation about what/how things need to be done before starting work; takes ownership for work; is open to new ideas; complies with rules and processes; appropriate dress; demonstrates behaviors consistent with the organization’s values; treats others with respect; understand and follows ethical guidelines; regularly shares expertise with team members to support continuous learning and improvement; works well with others, promotes teamwork.

Job Knowledge

Demonstrates basic knowledge and ability to use various applications/tools related to the function; is aware of metric goals; has the knowledge of policies, procedures and regulatory compliance; can identify problems/issues and tries to improve this based on program knowledge; requests help to understand complex issues; identifies problems and escalates accordingly.





HGS is a drug free work environment. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status.

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