Insurance Verifier

10 Children's Healthcare of Atlanta, Inc.; United States; On-site; USD 52,000 - 76,000; Full time

Job summary

Children's Healthcare of Atlanta is seeking a Patient Access professional to authorize and pre-certify services, verify insurance benefits, and coordinate with Financial Counseling. The role focuses on ensuring compliance with prior authorization requirements and communicating status to patients and teams.

The ideal candidate has experience in healthcare patient access, strong knowledge of medical terminology, and proficient MS Office skills.

Qualifications

• One year of experience in a healthcare patient access role (registration, scheduling).
• Preferred Qualifications Bachelor's degree in a related field.
• High school diploma or equivalent required.

Responsibilities

• Interviews patients/families to secure insurance coverage and eligibility for programs.
• Verifies insurance benefits and determines eligibility; communicates status to team.
• Pre-certifies procedures and coordinates with providers and payers as needed.
• Monitors authorization issues and communicates status to patients and staff.
• Acts as liaison between clinical staff, patients, and insurance to relay updates.

Skills

Medical terminology

Multitasking

Communication skills

MS Office

Education

High school diploma or equivalent

Bachelor’s degree (preferred)

Tools

Availity

MMIS

Payer websites

Job description

Job Family

Patient Access

Primary Location: 1575 Northeast Expy NE

Work Shift Day: Work Day(s) Monday-Friday Shift Start Time: 7:30 AM Shift End Time: 4:00 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.

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.

• One year of experience in a healthcare patient access role (registration, scheduling).
• Preferred Qualifications Bachelor's degree Experience in a pediatric hospital Education High school diploma or equivalent Certification Summary

• 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.

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 Knowledge of Availity, MMIS and insurance payer website.

May require travel within Metro Atlanta area as needed.

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.

Children's Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit organization, Children's is dedicated to making kids better today and healthier tomorrow. With 3 hospitals, 20 neighborhood locations and a total of 673 beds, Children's is the largest healthcare provider for children in Georgia and one of the largest pediatric clinical care providers in the country. Children's offers access to more than 60 pediatric specialties and programs and is ranked among the top children's hospitals in the country by U.S. News & World Report. Children's has been recognized as a Fortune 100 Best Place to Work, a Best Place for Working Mothers, and as a top employer for diversity and millennials.

We offer a comprehensive compensation and benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids better today and healthier tomorrow.