Insurance Verification Representative (H)

University of Miami•Medley, FL

19h•Onsite

About The Position

The University of Miami Health System (UHealth) is seeking an Insurance Verification Representative. This role is crucial for ensuring timely completion of accounts to support patient satisfaction and facilitate referral and authorization activities before the patient's date of service. The representative will be responsible for verifying eligibility and benefits, managing insurance information in UChart, and obtaining necessary authorizations for scheduled services. The position also involves significant customer service, educating patients and staff on insurance-related matters, and collaborating with various departments. UHealth is South Florida's only university-based health system, providing leading-edge patient care, research, and medical education through the Miller School of Medicine. It serves South Florida, Latin America, and the Caribbean, with physicians representing over 100 specialties. The University of Miami is recognized as a top research university and academic medical center, including the #1 eye hospital (Bascom Palmer Eye Institute) and an NCI-designated cancer center (Sylvester Comprehensive Cancer). It is an Equal Opportunity Employer, committed to diversity and 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 background 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

Nice To Haves

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
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 and POS 19 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
Participates in process improvement initiatives
Provides customer service and assist 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