Insurance Verifier

JOB DESCRIPTION

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Work Shift

Work Day(s)

Monday-Friday

Shift Start Time

8 : 00 AM

Shift End Time

4 : 30 PM

Worker Sub-Type

Regular

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.

Find your next career opportunity and make a difference doing what you love at Children’s.

Job Description

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. May initiate and perform revenue cycle activities required for pre-registration.

Works collaboratively with team members to provide quality service that ensures delivery of safe patient care and services.

Experience

At least one year of insurance verification experience

Preferred Qualifications

• Bachelor's degree
• Experience in a pediatric hospital

Education

High school diploma or equivalent

Certification Summary

No professional certifications required

Knowledge, Skills, and Abilities

• 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
• Must be able to speak and write in a clear and concise manner to convey messages.
• Proficient in Microsoft Word / Excel / Outlook
• May require travel within Metro Atlanta as needed

Job Responsibilities

• 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.
• Pre-screens doctor’s orders (scripts) received for new patients 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 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.

Primary Location Address

1575 Northeast Expy NE

Job Family

Patient Financial Services