Pediatric Insurance Verifier - Impactful Patient Access

Children's Healthcare of Atlanta; Brookhaven (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 insurance providers and healthcare teams. You will identify resources for families when plans do not cover services and collaborate with PFS and Managed Care on denied claims.

The role requires at least one year in insurance verification or a related verifier role, with a preference for experience in a pediatric hospital.

Qualifications

• Working knowledge of medical terminology and billing guidelines.
• Ability to multitask in a dynamic environment.
• Strong communication skills, both written and verbal.

Responsibilities

• Conducts in depth account review including denial management and liaison between clinical stakeholders and payor representation.
• Interviews patients and/or family members to secure insurance coverage, eligibility, and qualification for financial programs.
• Coordinates and performs verification of insurance benefits and communicates status to team members.
• Provides clinical information to support pre-certification for procedures with payors.
• Confirms prior authorization with insurance for scheduled procedures.
• Contacts physicians and patients to discuss rescheduling due to incomplete authorizations.
• Acts as liaison informing patients of changes and follow-ups regarding authorizations.
• Monitors scheduling to ensure eligibility in data systems.
• Pre-screens doctor orders for new patients to ensure completeness.
• Collaborates with PFS regarding denied claims and process improvements.
• Responds to inquiries related to authorization/pre-certification issues.
• Maintains knowledge of billing and insurance guidelines to ensure compliance.

Skills

Medical terminology

Multitask

Independent work

Clear communication

MS Office proficiency

Travel readiness

Education

High school diploma or equivalent

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Children's Healthcare of Atlanta is seeking an Insurance Verification Specialist to authorize and pre-certify services by coordinating with insurance providers and healthcare teams. You will identify resources for families when plans do not cover services and collaborate with PFS and Managed Care on denied claims.

The role requires at least one year in insurance verification or a related verifier role, with a preference for experience in a pediatric hospital.