Insurance Verifier

Children's Healthcare Of Atlanta • Brookhaven, GA

116d

About The Position

Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. The position involves authorizing and pre-certifying services by coordinating and performing activities required for verification and authorization of insurance benefits. The role also includes proactively identifying resources available for families if health plan does not include coverage for services, coordinating counseling services with Financial Counseling, and ensuring the standards of Surprise Billing are communicated. Collaboration with Patient Financial Services (PFS) and the Managed Care department regarding denied claims is also a key responsibility.

Requirements

• At least one year of insurance verification experience
• High school diploma or equivalent

Nice To Haves

• Bachelor's degree
• Experience in a pediatric hospital

Responsibilities

• Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of insurance benefits.
• Proactively identifies resources available for families if health plan does not include coverage for services.
• Coordinates counseling services with Financial Counseling and ensures the standards of Surprise Billing is communicated.
• Collaborates with Patient Financial Services (PFS) and Managed Care department regarding denied claims.
• Initiates and performs revenue cycle activities required for pre-registration.
• Conducts in-depth account review including denial management and clinical follow-up.
• Acts as a liaison between clinical stakeholders and payor representation.
• Interviews patients and/or family members to secure insurance coverage, eligibility, and qualification for various financial programs.
• Coordinates and performs verification of insurance benefits by contacting insurance providers and determining eligibility of coverage.
• Communicates status of verification/authorization process with appropriate team members in a timely manner.
• Provides clinical information as needed to insurance companies for completion of pre-certification process.
• Confirms prior authorization has been obtained from insurance company for all scheduled healthcare procedures.
• 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 any possible changes or updates.
• Monitors patients on schedule, ensuring eligibility and authorization information has been entered into data entry systems.
• Pre-screens doctor's orders for new patients to ensure completeness/appropriateness of scheduled appointment.
• Collaborates with Patient Financial Services (PFS) department regarding denied claims.
• Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
• Responds to all inquiries related to authorization/pre-certification issues.
• Develops and maintains knowledge in medical terminology, billing, and insurance guidelines.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED