Sr. Insurance Verification Representative (H)

University of Miami•Medley, FL

1d•Onsite

About The Position

The Insurance Verification Representative works in collaboration with the supervisory team to assist in training new hires and coaching team members. They ensure accounts are completed in a timely manner to support patient satisfaction and allow for referral and authorization activities prior to the patient’s date of service. This role involves verifying eligibility and benefits through various channels, adding and editing insurance information in UChart, completing checklists, documenting co-pays, and creating referrals and preauthorizations. The representative is responsible for meeting productivity standards, QA goals, and maintaining work queues. They also educate patients and practices on insurance-related matters, obtain authorizations and referrals, and communicate with patients and departments regarding authorization status and denials. Additionally, they provide customer service, identify process improvement opportunities, and perform other duties as assigned.

Requirements

Verification of eligibility and benefits via RTE in UChart, online insurance websites, telephone or other source of automated services
Add and/or edit insurance information in UChart such as validating that the correct guarantor account and plan listed in patient’s account with accurate subscriber information, policy number, and claims address and plan order
Completes the checklist and document co-pays
Creates referral, “Benefit only” or “Preauthorization”, and documents benefits information: deductible, co insurance and out of pocket benefits
Meets productivity standards for assigned work queue, QA goal of 95% or greater and maintains WQ current at 14 days out with minimum daily pending visits
Contacts Primary Care Physician offices and/or Health Plan to obtain authorization or referral for scheduled services according to authorization guideline listed in UHealth Contract Summary. Submits all necessary documentation required to process authorization request
Obtains authorization for both facility and provider for POS 22 clinics and provider only for POS 11 clinic locations
Enters and attaches authorization information in referral section of UChart
Approves referral and financially clear visits
Communicates with patients and/or departments regarding authorization denial and/or re-direction of patient by health plan or PCP office
Contacts the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status.
Provides exemplary customer service and assist patients and other UHealth staff with insurance related questions
Initiates, identifies, and tests process improvement opportunities, including, but not limited to, participating in project teams
Ensures that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process
Initiates collaboration with Department, Patient Access, and related stakeholders to ensure that timely and concise communication occurs
Demonstrates a high-level ability to solve difficult situations without supervisory intervention
Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines, provides feedback, and confirms mid to long term resolutions

Nice To Haves

Works in collaboration with supervisory team to assist in the training of new hires and coaching of team members
Initiates educating and acting as a resource to patients, primary care and specialty care practices within the UHealth system and externally

Responsibilities

Works in collaboration with supervisory team to assist in the training of new hires and coaching of team members
Accounts are completed in a timely manner in support of patient satisfaction and allow for referral and authorization activities prior to the patient’s date of service
Verification of eligibility and benefits via RTE in UChart, online insurance websites, telephone or other source of automated services
Add and/or edit insurance information in UChart such as validating that the correct guarantor account and plan listed in patient’s account with accurate subscriber information, policy number, and claims address and plan order
Completes the checklist and document co-pays
Creates referral, “Benefit only” or “Preauthorization”, and documents benefits information: deductible, co insurance and out of pocket benefits
Meets productivity standards for assigned work queue, QA goal of 95% or greater and maintains WQ current at 14 days out with minimum daily pending visits
Initiates educating and acting as a resource to patients, primary care and specialty care practices within the UHealth system and externally
Contacts Primary Care Physician offices and/or Health Plan to obtain authorization or referral for scheduled services according to authorization guideline listed in UHealth Contract Summary. Submits all necessary documentation required to process authorization request
Obtains authorization for both facility and provider for POS 22 clinics and provider only for POS 11 clinic locations
Enters and attaches authorization information in referral section of UChart
Approves referral and financially clear visits
Communicates with patients and/or departments regarding authorization denial and/or re-direction of patient by health plan or PCP office
Contacts the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status.
Provides exemplary customer service and assist patients and other UHealth staff with insurance related questions
Initiates, identifies, and tests process improvement opportunities, including, but not limited to, participating in project teams
Provides exemplary customer service and assist patients and other UHealth staff with insurance related questions
Ensures that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process
Initiates collaboration with Department, Patient Access, and related stakeholders to ensure that timely and concise communication occurs
Demonstrates a high-level ability to solve difficult situations without supervisory intervention
Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines, provides feedback, and confirms mid to long term resolutions
Performs other duties as assigned