Insurance Verification Representative - UHealth at SoLé Mia

University of Miami•Medley, FL

9d•Remote

About The Position

The University of Miami UHealth at SoLé Mia is seeking a full-time Insurance Verification Representative to work remotely. This role is part of the Central Insurance Verification (CIV) department and supports functions that create and drive a culture of empathy, service excellence, and patient-centered care across the UHealth System. The department values teamwork and collaboration to achieve the common goal of providing patient care. This position is responsible for verifying insurance eligibility, benefits, and obtaining authorizations for all insurance carriers for outpatient office visits and procedures scheduled within the UHealth Systems. The individual must project a positive image of the organization and department, directly impacting patient care, satisfaction, and the revenue cycle. This individual reports directly to the Insurance Verification Supervisor.

Requirements

High School Diploma or equivalent
Minimum 1 year of relevant work experience
Computer literate (EPIC scheduling and registration application experience a plus)
Strong written and oral communication skills
Able to work in a team environment
Graceful under pressure and stressful situations
Demonstrated knowledge of insurance, including authorization/referral guidelines and requirements
Demonstrated ability to communicate effectively in written and verbal form
Demonstrated ability to communicate effectively with physicians, customers, teammates, and other staff
Ability to interact and assist patients of all ages, cultural backgrounds, and with special needs, with a passion for providing excellent service and care
Ability to work under a high level of stress with time constraints while maintaining composure and sensitivity to each patient’s specific needs
Maintain a high level of diplomacy when dealing with stressful situations
Is innovative, proactive, and resourceful in problem solving
Any appropriate combination of relevant education, experience, and/or certifications may be considered.

Nice To Haves

EPIC scheduling and registration application experience
Bi-lingual knowledge a plus

Responsibilities

Complete accounts in a timely manner to support patient satisfaction and allow for referral and authorization activities prior to the patient’s date of service.
Verify eligibility and benefits via RTE in UChart, online insurance websites, telephone, or other automated services.
Add and/or edit insurance information in UChart, validating the correct guarantor account and plan, accurate subscriber information, policy number, claims address, and plan order.
Complete the checklist and document co-pay.
Create referrals (if applicable) for "Benefit only" or "Preauthorization" and document benefits information: deductible, co-insurance, and out-of-pocket benefits.
Meet productivity standards for assigned work queue, achieve a QA goal of 95% or greater, and maintain the work queue current at 14 days out with minimum daily pending visits.
Assist in educating and act as a resource to patients, primary care, and specialty care practices within the UHealth system and externally.
Contact Primary Care Physician offices and/or Health Plans to obtain authorization or referral for scheduled services according to authorization guidelines listed in the UHealth Contract Summary.
Submit all necessary documentation required to process authorization requests.
Obtain authorization for both facility and provider for POS 22 and POS 19 clinics, and provider only for POS 11 clinic locations.
Enter and attach authorization information in the referral section of UChart.
Communicate with patients and/or departments regarding authorization denial and/or re-direction of patients by health plan or PCP office.
Contact departments and/or patients when additional information is required or to alert them regarding pending authorization status.
Participate in process improvement initiatives.
Provide customer service and assist patients and other UHealth staff with insurance-related questions according to departmental standards.
Ensure patients are aware of issues regarding their financial clearance and are educated on the referral/authorization process.
Collaborate with Department and Patient Access teams to ensure timely and concise communication.
Ensure service recoveries and escalations are implemented with supervisor guidance and according to departmental standards and guidelines.
Perform other duties as assigned.