Insurance Verifier

Children's Healthcare of Atlanta; Atlanta (GA); On-site; USD 42,000 - 62,000; Full time

Job summary

Children's Healthcare of Atlanta is seeking an Insurance Verification Specialist to authorize and pre-certify services by coordinating with payors and families. The role involves proactive resource identification when coverage is lacking and collaboration with PFS and Managed Care for denied claims.

Strong communication, medical terminology knowledge, and Microsoft Office proficiency are essential. Responsibilities include handling pre-certifications, data entry, and ensuring accurate

Qualifications

• At least one year of insurance verification experience or one year as an associate insurance verifier.
• Bachelor's degree is preferred.
• Experience in a pediatric hospital is a plus.

Responsibilities

• Conduct in depth account review including denial management and liaison with payor representation.
• Interviews patients/family to secure insurance coverage and eligibility for financial programs.
• Verifies insurance benefits by contacting providers and determines eligibility and communicates status to team.
• Provides clinical information and medical justification for pre-certification.
• Ensures prior authorization notification is obtained for scheduled procedures.
• Coordinates with Patient Financial Services on denied claims and authorization issues.
• Monitors schedule and ensures eligibility/authorization data entry in systems.

Skills

Insurance verification

Multitasking

Communication

Medical terminology

Microsoft Word/Excel/Outlook

Education

High school diploma or equivalent

Bachelor's degree

Tools

PFS systems

Medical billing software

Job description

Work Shift

Day

Work Day(s)

Monday-Friday

Shift Start Time

7:30 AM

Shift End Time

4:00 AM

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 or one year in an associate insurance verifier role

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-solveAbility 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.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

5461 Meridian Mark Rd

Job Family

Patient Access