Pediatric Insurance Verifier & Pre-Auth Specialist

Children's Healthcare of Atlanta; Brookhaven (GA); On-site; USD 42,000 - 60,000; Full time

Job summary

Children’s Healthcare of Atlanta is seeking a Patient Access Specialist to authorize and pre-certify services by coordinating verification of insurance benefits. You will identify resources for families if coverage is lacking and collaborate with Financial Counseling to ensure compliance with surprise billing standards.

The role includes working with Patient Financial Services and Managed Care on denied claims, and may initiate revenue cycle activities for pre-registration.

Qualifications

• One year of experience in a healthcare patient access role (registration, scheduling).
• Strong communication skills and medical terminology knowledge.
• Ability to multitask and work independently in a changing environment.

Responsibilities

• Interviews patients/families to secure insurance coverage and eligibility.
• Verifies and communicates insurance benefits status for pre-certification.
• Provides clinical information to insurance companies for approvals when needed.
• Ensures prior authorization is obtained for scheduled procedures.
• Coordinates with physicians and insurance to discuss rescheduling due to authorizations.
• Acts as liaison between clinical staff, patients, and insurance providers.
• Monitors schedule for eligible authorization data entry in systems.
• Pre-screens orders for new patients to ensure completeness.
• Collaborates with PFS on denied claims and trends in authorization issues.
• Maintains up-to-date knowledge of medical terminology and billing guidelines.

Skills

Medical terminology

Multitasking

Communication

Attention to detail

Customer service

Education

Bachelor's degree

Tools

Availity

MMIS

Insurance payer websites

Job description

Children’s Healthcare of Atlanta is seeking a Patient Access Specialist to authorize and pre-certify services by coordinating verification of insurance benefits. You will identify resources for families if coverage is lacking and collaborate with Financial Counseling to ensure compliance with surprise billing standards.

The role includes working with Patient Financial Services and Managed Care on denied claims, and may initiate revenue cycle activities for pre-registration.