Insurance Verifier
About The Position
The Insurance Verifier authorizes and pre-certifies services by coordinating and completing 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. The Insurance Verifier collaborates with Patient Financial Services and Managed Care regarding 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 schedule is Monday through Friday, 8:00 AM to 4:30 PM, on the day shift. Travel within metro Atlanta may be required as needed. The position is based at 2220 North Druid Hills Road.
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 serve as a liaison between clinical stakeholders and payor representatives.
- Interview patients and/or family members to obtain information about insurance coverage, eligibility, and qualification for financial programs.
- Verify insurance benefits by contacting insurance providers, determining coverage eligibility, and promptly communicating verification and authorization status to appropriate team members.
- Provide clinical information to insurance companies as needed, emphasizing medical justification for procedures or services during pre-certification.
- Confirm that referring or servicing physicians have obtained required prior-authorization notification or confirmation for scheduled procedures in the assigned department or area.
- Contact referring physicians and/or patients to discuss rescheduling procedures when authorizations are incomplete or partial.
- Act as a liaison among clinical staff, patients, referring physician offices, and insurers; communicate updates and follow-up regarding authorization delays, denials, pending status, and changes; offer assistance and relay or document messages about procedure or service authorization.
- Monitor patient schedules to ensure eligibility and authorization information is entered into data-entry systems.
- Pre-screen orders or scripts for new patients to ensure scheduled appointments are complete and appropriate.
- Collaborate with Patient Financial Services to provide information related to denied claims.
- Monitor insurance authorization issues, identify 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
Education Level
High school or GED
