Pediatric Insurance Verifier & Pre-Auth Specialist

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

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