Insurance Verification Representative (H)

University of Miami•Medley, FL

3d•Onsite

About The Position

The Insurance Verification Representative is responsible for verifying patient insurance eligibility and benefits to ensure smooth referral and authorization processes prior to the date of service. This role involves direct interaction with patients, physicians' offices, and health plans to gather necessary information and documentation. The position also plays a key role in customer service, assisting patients and staff with insurance-related inquiries and ensuring financial clearance. The University of Miami offers a comprehensive benefits package and is committed to transforming lives through education, research, innovation, and service.

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 backgrounds, 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 eligibility and benefits via RTE in UChart, online insurance websites, telephone, or other automated services.
Add and/or edit insurance information in UChart, validating guarantor accounts, plans, subscriber information, policy numbers, claims addresses, and plan order.
Complete checklists and document co-pays.
Create referrals (e.g., "Benefit only" or "Preauthorization") and document benefit information including deductible, co-insurance, and out-of-pocket benefits.
Meet productivity standards, achieve a QA goal of 95% or greater, and maintain work queues current within 14 days.
Assist in educating patients, primary care, and specialty care practices within the UHealth system and externally.
Contact Primary Care Physician offices and/or Health Plans to obtain authorizations or referrals for scheduled services according to authorization guidelines.
Submit all necessary documentation required to process authorization requests.
Obtain authorizations for both facility and provider for specific clinic POS (Point of Service) locations.
Enter and attach authorization information in the referral section of UChart.
Approve referrals and financially clear visits.
Communicate with patients and/or departments regarding authorization denials or re-directions.
Contact departments and/or patients when additional information is required or to alert them about pending authorization status.
Participate in process improvement initiatives.
Provide customer service and assist patients and other UHealth staff with insurance-related questions.
Ensure patients are aware of 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 with supervisor guidance.
Perform other duties as assigned.