Insurance Verifier

Children's Healthcare of Atlanta

About The Position

Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits for services. Proactively identifies resources for patients and may communicate with families the financial resources available to patients whose health plan does not include coverage for services, coordinating counseling services with Financial Counseling as required. Collaborates with Appeals department to overturn claims denied as well as Managed Care department in contract negotiations. May initiate and perform revenue cycle activities required for pre-registration. Works collaboratively with team members to provide quality service to proactively support efforts that ensure delivery of safe patient care and services and promote a safe environment at Children's Healthcare of Atlanta.

Requirements

Completion of an externship approved by Children’s or one year of experience in insurance verification or an assigned clinical discipline
High school diploma or equivalent
Working knowledge of basic medical terminology
Demonstrated multitasking and problem-solving skills
Ability to work independently in a changing environment and handle stressful situations
Must pass typing test with at least 50 words per minute
Demonstrated arithmetic and word mathematical problem-solving skills
Must be able to speak and write in a clear and concise manner to convey messages and ensure that the customer understands whether clinical or non-clinical
Proficient in Microsoft Word/Excel/Outlook, SMS, Epic, CSC Papers, scheduling systems (e.g., NueMD, RIS, SIS), IMS Web, Report Web, and insurance websites (e.g., BCBS, RADMD, WebMD, Wellcare, Amerigroup, UHC)
Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating
May require travel within Metro Atlanta as needed
Strives for adult-to-adult relationships with colleagues, subordinates, and superiors

Nice To Haves

Bachelor's degree
Experience in a pediatric hospital

Responsibilities

Interviews patients and/or family members as needed to secure information concerning insurance coverage, eligibility, and qualification for various financial programs.
Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of coverage and communicates status of verification/authorization process with appropriate team members in a timely and efficient manner.
Provides clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for completion of pre-certification process.
Confirms referring physician has obtained prior authorization as needed from insurance company for all scheduled healthcare procedures within assigned department/area.
Contacts referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial authorizations.
Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure/service.
Maintains tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment.
Collaborates with Appeals department to provide all related information to overturn claims denied.
Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
Responds to all inquiries from throughout the system and outside related to authorization/pre-certification issues.
Provides ongoing communication to physician offices, patients/families, and others as necessary to resolve insurance authorization issues.