Insurance verifier

Children's Healthcare of Atlanta•Brookhaven, GA

1d•Onsite

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. The Insurance Verifier collaborates with Patient Financial Services and Managed Care on denied claims and may perform revenue-cycle activities for pre-registration. The role works collaboratively with team members to support quality service and safe patient care. The position is based at 1575 Northeast Expy NE. The schedule is Monday through Friday, 8:00 AM to 4:30 PM, with possible travel within metro Atlanta 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 serve as a liaison between clinical stakeholders and payor representatives.
Interview patients and/or family members to obtain insurance coverage, eligibility, and qualification information for financial programs.
Verify insurance benefits by contacting insurance providers, determining eligibility and coverage, and communicating verification and authorization status to appropriate team members in a timely manner.
Provide clinical information to insurance companies, emphasizing medical justification for procedures or services, to complete pre-certification.
Confirm that referring and/or servicing physicians have obtained required prior-authorization notification or confirmation 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.
Liaise among clinical staff, patients, referring physicians’ offices, and insurers; communicate authorization delays, denials, pending status, updates, follow-up steps, and financial-support options, and relay or document related messages.
Monitor patient schedules and ensure eligibility and authorization information is entered into data-entry systems.
Pre-screen new-patient doctor’s orders 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.