An Insurance Verifier is responsible for the authorization and pre-certification of services by coordinating and performing activities required for verification and authorization of insurance benefits for services. Proactively identifies and communicates with families the financial resources available to patients, whose health plan does not include coverage for services, coordinating counseling services with Financial Counseling as required. Collaborates with Appeals department to overturn claims denied as well as the Managed Care Department in contract negotiations. May initiate and perform revenue cycle activities required for pre-registration.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
Initiates and performs revenue cycle activities by interviewing patients and/or family members as needed, to secure information concerning insurance coverage, eligibility, and qualification for various financial programs.
Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of coverage, and communicates the status of verification/authorizationprocess with appropriate team members in a timely and efficient manner.
Provides clinical information as needed, emphasizing the medical justification for procedure/service to insurance companies for completion of pre-certification process.
Ensures referring physician obtains prior authorization as needed, from insurance company for all scheduled healthcare procedures within assigned department/area.
Contacts referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial authorizations.
Acts as liaison between clinical staff, patients, referring physician's office and insurance payers by informing patients and families of procedures authorization delays/denials, answering questions, offering assistance, relaying messages, pertaining to the authorization of procedure/service.
May perform revenue cycle activities required for pre-registration and registration, facilitating insurance pre-certification and authorization.
Maintains tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
Contacts parents/guardians regarding co-payment amounts prior to service date.
Pre-screens doctor's orders (scripts) received for new patient to ensure completeness/appropriateness of scheduled appointment.
Responds to all inquiries from throughout the system and outside related to authorization/pre- certification issues.
Collaborates with Appeals department to provide all related information to overturn claims denied.
Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
Provides on-going communication and training to physician offices, patients/families and others as necessary to resolve insurance authorization-related departmental issues.
May answer telephone, greet patients and visitors, and proactively assist with waiting room management and tidiness.
May have additional departmental specific duties as necessary.
High School Diploma or equivalent. Bachelor Degree preferred.
Two (2) years healthcare experience required. Pediatric hospital experiences a plus.
Working knowledge of Basic Medical Terminology
Demonstrated multi-tasking and problem solving skills.
Ability to work independently in a changing environment and handle stressful situations.
Must pass typing test with at least 50 words per minute
Demonstrated arithmetic and word mathematical problem solving skills with a score of at least 75%.
Must be able to speak and write in a clear and concise manner in order to convey messages and ensure that the customer understands, whether customer is clinical or non-clinical.
Proficiency in Windows (Word, Excel, Outlook), SMS, EPIC, CSC Papers, Scheduling systems (Nuemd, RIS, SIS), IMS Web, Report Web, and websites for insurance payers (BCBS, RADMD, WebMD, Wellcare, Amerigroup, UHC). Must pass Windows Basic Skills Competency test with at least an 80%.
May require travel within Metro Atlanta as needed.
Children's Rehabilitation at Mount Zion
Hours Per Week
Children's Healthcare of Atlanta - 20 months ago
Children's Healthcare of Atlanta is a not-for-profit hospital system that specializes in pediatric health care, research, and...