Insurance Verification Representative (H)

University of Miami•Medley, FL

1d•Onsite

About The Position

The Insurance Verification Representative is responsible for verifying patient insurance eligibility and benefits to ensure timely processing of referrals and authorizations prior to the date of service. This role involves direct interaction with patients, healthcare providers, and insurance companies to resolve insurance-related issues and facilitate patient care. The position requires strong communication skills, attention to detail, and the ability to work effectively in a fast-paced environment.

Requirements

Demonstrated knowledge of insurances, including authorization/referrals 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 background and with special needs.
Ability to work under a high level of stress with time constraints while maintaining composure and sensitivity.
Maintain a high level of diplomacy when dealing with stressful situations.
Is innovative, proactive and resourceful in problem solving.

Nice To Haves

Bi-lingual knowledge a plus.

Responsibilities

Verify insurance eligibility and benefits using various methods including UChart, online insurance websites, telephone, and automated services.
Add and/or edit insurance information in UChart, ensuring accuracy of guarantor accounts, plan details, subscriber information, policy numbers, and claims addresses.
Complete checklists and document co-pays.
Create referrals and document benefit information such as deductibles, co-insurance, and out-of-pocket maximums.
Meet productivity standards, achieve a QA goal of 95% or greater, and maintain work queues within established timelines.
Educate patients and assist primary care and specialty care practices within the UHealth system and externally.
Contact Primary Care Physician offices and/or Health Plans to obtain necessary authorizations or referrals.
Submit all required documentation for authorization requests.
Obtain authorizations for facility and provider services for specific clinic locations.
Enter and attach authorization information in the referral section of UChart.
Approve referrals and financially clear visits.
Communicate with patients and departments regarding authorization denials or re-directions.
Contact departments and/or patients for additional information or to provide updates on authorization status.
Participate in process improvement initiatives.
Provide customer service and assist patients and UHealth staff with insurance-related questions.
Ensure patients are informed about financial clearance issues and educated on the referral/authorization process.
Collaborate with Department and Patient Access teams for timely and concise communication.
Implement service recoveries and escalations under supervisor guidance.
Perform other duties as assigned.