Part Time Insurance Verification Specialist

UnitedHealth Group • Brookfield, WI

201d • $16 - $27 • Remote

About The Position

The Insurance Verification Specialist provides detailed and timely communication to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home for approximately 4-6 weeks. If you are located within commutable distance from the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

• High School Diploma/GED (or higher)
• 1+ years of experience in medical billing, medical insurance verification, managed care and/or patient registration
• 1+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers
• 1+ years of experience working with an EMR system
• Intermediate level of proficiency with Microsoft Office products
• Ability to work 20 hours per week, from 8:00am - 4:30pm CST Mondays and Fridays and 8:00am-12:00pm Wednesdays
• Must be 18 years of age or older

Nice To Haves

• 1+ years of experience in an acute care billing/insurance verification/managed care/registration department
• Previous experience with prior authorizations and referrals
• Previous experience with Epic medical record and medical terminology
• Epic experience

Responsibilities

• Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral
• Initiate contact with payers to complete insurance verification activities to prevent delays in care due to missing authorizations
• Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered
• Navigate EMR, insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization
• Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care
• Update health record with accurate information regarding insurance coverage based on information gathered during verification &/or authorization process
• Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, departments & modalities across the continuum
• Identify/escalate barriers to obtaining authorization to the insurance company or per department protocol
• Respond to insurance company inquiries for information including consent forms, pre-authorization forms, 2nd opinion forms & referral forms
• Coordinate with providers, payers, departments, & patients regarding authorization status and options & document outcomes in the EMR
• Confirm payment coverage including the initiation of insurance & managed care authorizations
• Communicate with providers & clinical delegates to resolve any outstanding information regarding pre-authorization & referral requirements
• Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits assigned
• Complete assigned tasks in EMR work queues & bring work lists to completion
• Generate forms to insurance companies: consent, pre-authorization, second opinion and referral
• Notify provider of denied procedure/request for peer-to-peer discussion with insurance company & adjust authorization status accordingly
• Work independently & as part of a team in conjunction with Utilization Review/other departments as necessary to provide appropriate clinical information from the EMR to appeal the denials from the insurance company
• Follow-up discharge status of patients & relay information to insurance carriers as they require
• Actively participate in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriately
• Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization

Benefits

• $2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED