Insurance Verifier- Chantilly Rehab
About The Position
The Insurance Verifier authorizes and pre-certifies services by coordinating and performing insurance benefit verification and authorization activities. The role proactively identifies resources for families when their health plan does not cover services, coordinates counseling with Financial Counseling, and ensures Surprise Billing standards are communicated. It collaborates with Patient Financial Services (PFS) and Managed Care on denied claims and may perform revenue-cycle activities required for pre-registration. The position works collaboratively with team members to support quality service and safe patient care. The position is based at 1605 Chantilly Dr NE. The listed workdays are Monday through Friday, and the shift is identified as day shift. The posted shift start time is 7:30 AM and the end time is listed as 4:00 AM. Travel within metro Atlanta may be required as needed.
Requirements
- High school diploma or equivalent.
- At least one year of insurance verification experience or one year in an associate insurance verifier role.
- Working knowledge of basic medical terminology.
- Demonstrated ability to multitask and problem-solve.
- Ability to work independently in a changing environment and handle stressful situations.
- Ability to speak and write clearly and concisely.
- Proficiency in Microsoft Word, Excel, and Outlook.
Nice To Haves
- Bachelor's degree.
- Experience in a pediatric hospital.
Responsibilities
- Conduct in-depth account reviews, including denial management and clinical follow-up, and act as a liaison between clinical stakeholders and payor representatives.
- Interview patients and/or family members to secure insurance coverage, eligibility, and qualification for financial programs.
- Verify insurance benefits by contacting insurance providers, determine coverage eligibility, and communicate verification and authorization status to appropriate team members in a timely and efficient manner.
- Provide clinical information to insurance companies as needed, emphasizing medical justification for procedures or services during pre-certification.
- Confirm that referring and/or servicing physicians have obtained required prior authorization or notification for scheduled healthcare procedures in the assigned department or area.
- Contact referring physicians and/or patients to discuss rescheduling procedures when authorizations are incomplete or partial.
- Serve as a liaison among clinical staff, patients, referring physician offices, and insurers by communicating authorization delays, denials, pending statuses, updates, follow-up steps, and financial-support options; relay and document related messages.
- Monitor patient schedules to ensure eligibility and authorization information is entered into data-entry systems.
- Pre-screen new-patient physician orders to ensure they are complete and appropriate for scheduled appointments.
- Collaborate with Patient Financial Services to provide information related to denied claims.
- Monitor authorization issues for trends and participate in process-improvement initiatives.
- Respond to inquiries about authorization and pre-certification issues.
- Develop and maintain knowledge of medical terminology, billing, and insurance guidelines to support regulatory compliance.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
