Insurance Verification Rep

Piedmont Cancer Institute•Atlanta, GA

18h•Onsite

About The Position

The Insurance Verification Representative plays a critical role in the revenue cycle by performing timely and accurate insurance and benefits verification, and pre-certification of Radiology imaging for PCI patients. The IVR demonstrates a high level of accountability to ensure accurate selection of insurance and documentation of benefits coverage. The successful candidate will be flexible and able to multi-task in a fast-paced, high-volume setting. Our ideal candidate has a fundamental understanding of how insurance verification impacts the revenue cycle. Previous insurance verification and prior authorization experience is crucial for success in this role. This position is located at our Central Business Office in Atlanta and reports to the Insurance Verification Supervisor.

Requirements

Previous insurance verification and prior authorization experience is crucial for success in this role.
Fundamental understanding of how insurance verification impacts the revenue cycle.
Ability to commute/relocate to Atlanta, GA 30309.
High school or equivalent (Preferred)
Microsoft Excel: 1 year (Preferred)
Insurance verification: 1 year (Preferred)

Responsibilities

Coordinate with clinic staff to add and update insurance and perform verification and reverification of insurance benefits.
Determination of eligibility, coverage details, and benefits using online resources or phone calls with the insurance company.
Communicates status of verification/authorization process with appropriate team members in a timely and efficient manner.
Confirms referral requirements for individual plans and works with referring physician offices as needed to obtain referrals for all scheduled specialist services, including referrals for additional office visits.
Ensures verification details for all practice/infusion services are documented in the patient’s record.
Verifies completeness and accuracy of all information prior to resolving tasks in the work queue.
Work productively and efficiently from a task-based work queue. Volume may vary, but the Insurance Verification Representative is expected to maintain an acceptable level of productivity as determined by the Insurance Verification Supervisor to meet business needs.
Acts as liaison between clinical staff, patients, referring physician offices, and insurance by informing all parties of coverage issues, including answering questions, helping, and relaying messages pertaining to verification and authorization.
Contacts insurance companies to determine preauthorization requirements for outpatient imaging studies.
Reviews and submits clinical information to support medical necessity of Radiology orders.
Calls insurance companies or uses online tools to obtain preauthorization prior to service date.
Follows-up timely and thoroughly.
Analyzes, investigates, and resolves all authorization denials and peer-to-peer requests.
Researches and assists with denied preauthorization or predeterminations.
File appeals and reconsiderations for denied authorizations
Utilize reports to initiate preauthorization on Radiology scans and communicate across functional areas to ensure authorization is in place at least 48 hours prior to the scheduled procedure.
Anticipate work needs, and organize workflow, follow through with minimal direction, and follow up independently and on own initiative.
Multi-task and use time efficiently, perform professionally at a high level under tight deadlines and in a fast paced ever-evolving work environment, and successfully prioritize, and adapt to changing demands.
Identify problems or trending issues and provide suggestions for findings and to determine resolutions
Respond timely to emails and telephone messages as appropriate.
Communicate issues to management, including payer, system or escalated account issues.
Regularly meet with Insurance Verification Supervisor to discuss and resolve verification issues or preauthorization obstacles.
Regularly attend weekly/monthly department meetings.
Regularly attend monthly Revenue Cycle Department meetings.
Other duties as assigned.
Abide by the Health Insurance Portability and Accountability Act (HIPAA) when handling any and all protected health information (PHI).
Insurance Verification Representative will have access to PHI and ePHI in the course of his/her duties. Applying the minimum necessary standard of HIPAA, this employee has access to the minimum amount of designated record sets required to perform his or her duties.