Senior Insurance Verifier

Children's Healthcare of Atlanta•Brookhaven, GA

1d•Onsite

About The Position

Serves as expert/senior team member while participating in authorization and pre-certification of healthcare services to prevent claims denial and/or appointment cancellation/rescheduling due to authorization issues (e.g., ensuring referring physician obtains prior authorization from insurance company for all scheduled healthcare procedures within assigned department/area). Provides ongoing communication and training to physician offices, patients/families, and others to resolve authorization- related departmental issues. Coordinates changes in process and provides learning materials and resources. Proactively identifies and communicates financial resources available if health plan does not include coverage for services. Coordinates counseling services with Financial Counseling. Collaborates with Patient Financial Services (PFS) department regarding denied claims. Initiates and performs revenue cycle activities required for insurance verification, authorization, and pre-registration. Works collaboratively with team members to provide quality service. Supports the leadership team as needed.

Requirements

3 years of healthcare insurance verification experience, including authorizations
Epic experience
High school diploma or equivalent
Certified Healthcare Access Associate Certification (CHAA) within six (6) months of employment as Senior Insurance Verifier
Working knowledge of medical terminology
Demonstrated ability to multitask and problem-solve
Ability to work independently in a changing environment and handle stressful situations.
Ability to read, analyze and interpret medical and supply publications, technical procedures and/or training tools
When applicable, specialized focus on assignment or location, must be able to analyze in depth account review including but not limited to, denial management, clinical follow up, and act as a liaison between clinical stakeholders and payor representation
Excellent verbal and written communication skills
Must be able to speak and write in a clear and concise manner to convey messages
Proficient in Microsoft Word/Excel/Outlook
Knowledge of Availity, MMIS and insurance payer websites

Nice To Haves

Bachelor's degree
Experience in a pediatric hospital
Epic SuperUser
May require travel within Metro Atlanta as needed

Responsibilities

Assists Management Team with quality assurance, productivity monitoring and monthly reporting.
Performs daily quality audits to ensure all healthcare services are authorized and documented accurately and timely.
Conducts in depth account review including but not limited to, denial management, clinical follow up, and 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 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 and/or servicing physician has obtained notification/confirmation of 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 any possible changes, updates, responses or follow up. Discussion points may include the following: authorization delays, authorization denials, pending status, answering questions regarding status changes, offering assistance, providing follow up steps for financial support and relaying/documenting messages pertaining to authorization of procedure/service.
Monitors patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.
Depending on payer, pre-screens new patient doctor’s orders (scripts) to ensure completeness/appropriateness of scheduled appointment.
Collaborates with Patient Financial Services (PFS) department to provide all related information regarding denied claims.
Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
Responds to all inquiries within the system and outside related to authorization/pre-certification issues.
Develops and maintains knowledge in medical terminology, billing and insurance guidelines to ensure Children’s remains compliant with all regulatory expectations.
Will assist with training, shadowing, and quality assurance for new employees.