Insurance Verification Representative - UHealth at SoLé Mia

University of Miami•Medley, FL

1d•Remote

About The Position

The University of Miami UHealth at SoLé Mia is opening in September 2025 and will provide high-quality academic medicine to North Miami, Aventura, and surrounding communities. The UHealth Central Business Office - UHealth SoLé Mia has an exciting opportunity for a full-time Insurance Verification Representative to work remotely. This position is part of the Central Insurance Verification (CIV) department and is responsible for supporting functions that assist in creating and driving a culture of empathy, service excellence, and delivery of patient-centered care that impacts the patient experience across the UHealth System. The department thrives on teamwork and collaboration, aiming to provide the best care for patients. This role is responsible for verifying insurance eligibility, benefits, and obtaining authorization 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, as this position directly impacts patient care, patient satisfaction, and the revenue cycle. The 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

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-pay.
Creates referral if applicable, “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
Assists in educating and acts 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 UHealth Contract Summary.
Submits all necessary documentation required to process authorization request
Obtains authorization for both facility and provider for POS 22 and POS 19 clinics and provider only for POS 11 clinic locations
Enters and attaches authorization information in referral section of UChart
Communicates with patients and/or departments regarding authorization denial and/or re-direction of patients by health plan or PCP office
Contact the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status
Participates in process improvement initiatives
Provides customer service and assists patients and other UHealth staff with insurance related questions according to departmental standards
Ensures that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process
Collaborates with Department and Patient Access teams to ensure that timely and concise communication occurs.
Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines
Performs other duties as assigned