Insurance Verifier

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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

Experience

• At leastoneyearofinsuranceverificationexperience 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-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
• May require travel within metro Atlanta as needed

Job Responsibilities

• Conductsindepthaccountreview including but notlimitedto,denialmanagement,clinicalfollow up, and actsas aliaison betweenclinical stakeholders andpayorrepresentation.
• Interviewspatientsand/or familymemberstosecure insurancecoverage,eligibility, andqualificationforvariousfinancialprograms.
• Coordinates and performsverificationof insurancebenefitsbycontacting insuranceprovider and determiningeligibilityofcoverage andcommunicatesstatusof verification/authorizationprocesswithappropriate teammembersin atimely and efficientmanner.
• Providesclinicalinformationas needed,emphasizingmedicaljustificationfor procedure/serviceto insurancecompaniesforcompletionof pre-certification process.
• Confirmsreferringphysicianand/orservicingphysician hasobtainednotification/confirmationof priorauthorizationasneededfrom insurancecompanyfor allscheduled healthcareprocedures withinassigned department/area.
• Contactsreferringphysicians andor/patientsto discussreschedulingofprocedures dueto incomplete/partialauthorizations.
• Actsasliaison betweenclinicalstaff,patients,referring physician’soffice, and insurancebyinformingpatients andfamiliesof anypossible changes,updates,responsesorfollow up. Discussionpoints may includethefollowing:authorization delays,authorizationdenials,pendingstatus, answeringquestions regardingstatus changes, offeringassistance, providingfollowupstepsforfinancialsupport andrelaying/documenting messagespertainingtoauthorizationofprocedure/service.
• Monitorspatientsonschedule,ensuring thateligibility andauthorizationinformation hasbeen entered into dataentrysystems.
• Pre-screens doctor’s orders (scripts) received for new patients to ensurecompleteness/appropriateness of scheduled appointment.
• Collaborateswith Patient FinancialServices(PFS) departmenttoprovideall relatedinformation regardingdeniedclaims.
• Monitors insuranceauthorizationissuestoidentify trends and participatesinprocessimprovementinitiatives.
• Respondsto allinquiries relatedtoauthorization/pre-certificationissues.
• Develops and maintainsknowledgeinmedicalterminology,billing and insuranceguidelinestoensure Children’sremainscompliantwith 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.

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