Insurance Verifier
Children's Healthcare of Atlanta
full-time
Posted on:
Location Type: Remote
Location: United States
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Job Level
About the role
- Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits
- Proactively identifies resources available for families if health plan does not include coverage for services
- Coordinates counseling services with Financial Counseling and ensures the standards of Surprise Billing is communicated
- Collaborates with Patient Financial Services (PFS) and Managed Care department regarding denied claims
- May initiate and perform revenue cycle activities required for pre-registration
- Works collaboratively with team members to provide quality service that ensures delivery of safe patient care and services
- Conducts in depth account review including but not limited to, denial management, clinical follow up, and acts as a liaison between clinical stakeholders and payor representation
- Interviews patients and/or family members to secure 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
- Confirms referring physician and/or servicing physician has obtained notification/confirmation of 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 by informing patients and families of any possible changes, updates, responses or follow up
- Monitors patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems
- Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment
- Collaborates with Patient Financial Services (PFS) department to provide all related information regarding denied claims
- Monitors insurance authorization issues to identify trends and participates in process improvement initiatives
- Responds to all inquiries related to authorization/pre-certification issues
- Develops and maintains knowledge in medical terminology, billing and insurance guidelines to ensure compliance with all regulatory expectations
Requirements
- At least one year of insurance verification experience
- Bachelor's degree (preferred)
- Experience in a pediatric hospital (preferred)
- High school diploma or equivalent
- Working knowledge of basic medical terminology
- Ability to multitask and problem-solve
- Ability to work independently in a changing environment and handle stressful situations
- Must be able to speak and write in a clear and concise manner to convey messages
- Proficient in Microsoft Word/Excel/Outlook
Benefits
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Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
insurance verificationmedical terminologybilling guidelinesauthorizationdenial managementrevenue cycle activitieseligibility determinationfinancial programs
Soft Skills
multitaskingproblem-solvingindependencestress managementclear communication
Certifications
Bachelor's degreeHigh school diploma or equivalent