Insurance Verification Representative II

Cincinnati Children's

2d•$21 - $26•Remote

About The Position

JOB RESPONSIBILITIES Problem Resolution - Serve as first level problem resolution for both internal and external customers. Initiate calls to appropriate parties both internal and external to resolve issues. Escalate to appropriate staff regarding system errors, recurring divisional problems/errors identified within work queues or reports. Work with team to suggest/recommend changes to systems or work processes. Collaboration - Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions. Participate in Department Meetings to share payer trends related to Pre-Authorizations. Quality Improvement - Maintain and update departmental system, including templates and payer and physician information. Identify opportunity for improvement in Departmental processes and communicate findings to Management for evaluation. Productivity - Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Pre-Authorization - Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient. JOB QUALIFICATIONS High school diploma or equivalent 2+ years of work experience in a related job discipline About Us At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s. Cincinnati Children's is: Recognized by U.S. News & World Report as a top 10 best Children's Hospitals in the nation for more than 15 years Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding Recognized as one of America’s Best Large Employers (2025), America’s Best Employers for New Grads (2025) One of the nation's America’s Most Innovative Companies as noted by Fortune Consistently certified as great place to work A Leading Disability Employer as noted by the National Organization on Disability Magnet® designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC) We Embrace Innovation—Together. We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us. Comprehensive job description provided upon request. Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability Cincinnati Children’s is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability Completion of Application You will be asked to fully complete each page of the application to the best of your knowledge. Failure to complete all parts of the application will result in a delay in processing and/or rejection of the application. Need Assistance or Accommodation? Assistance with Application: For assistance or technical support, email [email protected]. Accommodation: We provide reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require an accommodation in the application process, email [email protected].

Requirements

High school diploma or equivalent
2+ years of work experience in a related job discipline

Responsibilities

Serve as first level problem resolution for both internal and external customers.
Initiate calls to appropriate parties both internal and external to resolve issues.
Escalate to appropriate staff regarding system errors, recurring divisional problems/errors identified within work queues or reports.
Work with team to suggest/recommend changes to systems or work processes.
Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments.
Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions.
Participate in Department Meetings to share payer trends related to Pre-Authorizations.
Maintain and update departmental system, including templates and payer and physician information.
Identify opportunity for improvement in Departmental processes and communicate findings to Management for evaluation.
Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards.
Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems.
Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge.
Collaborate with internal and external resources regarding specific authorizations scenarios.
Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.