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

• Oneyear ofexperiencein ahealthcarepatientaccess role (registration, scheduling)

Preferred Qualifications

• Bachelor'sdegree
• Experiencein apediatrichospital

Education

• High school diploma or equivalent

Certification Summary

• No professional certifications required

Knowledge, Skills, and Abilities

• Workingknowledgeofbasicmedicalterminology
• Demonstratedabilitytomultitaskandproblem-solve
• Abilitytoworkindependentlyin achangingenvironmentandhandlestressfulsituations
• Mustbeabletospeakandwritein aclearandconcisemannertoconveymessages
• Proficientin MicrosoftWord/Excel/Outlook
• KnowledgeofAvaility,MMISandinsurancepayerwebsite.
• MayrequiretravelwithinMetroAtlantaareaasneeded

Job Responsibilities

• Interviewspatientsand/or familymemberstosecureinsurancecoverage,eligibility,andqualificationforvariousfinancialprograms.
• Coordinatesand performsverificationofinsurancebenefitsbycontactinginsuranceprovideranddeterminingeligibilityofcoverageandcommunicatesstatusofverification/authorizationprocesswithappropriateteammembersin atimelyand efficientmanner.
• Providesclinicalinformationasneeded,emphasizingmedicaljustificationfor procedure/servicetoinsurancecompaniesforcompletionof pre-certificationprocess.
• Confirmsreferringphysicianand/orservicingphysicianhasobtainednotification/confirmationofpriorauthorizationasneededfrominsurancecompanyforallscheduledhealthcareprocedureswithinassigneddepartment/area.
• Contactsreferringphysiciansandor/patientstodiscussreschedulingofproceduresduetoincomplete/partialauthorizations.
• Actsasliaisonbetweenclinicalstaff,patients,referringphysician’soffice,andinsurancebyinformingpatientsandfamiliesofanypossiblechanges,updates,responsesorfollow-up.Discussionpoints mayincludethefollowing:authorizationdelays,authorizationdenials,pendingstatus,answeringquestionsregardingstatuschanges, offeringassistance,providingfollowupstepsforfinancialsupportandrelaying/documentingmessagespertainingtoauthorizationofprocedure/service.
• Monitorspatientsonschedule,ensuringthateligibilityandauthorizationinformationhasbeenenteredintodataentrysystems.
• Pre-screensdoctor’sorders(scripts)receivedfornewpatientstoensure completeness/appropriateness ofscheduledappointment.
• CollaborateswithPatientFinancialServices(PFS)departmenttoprovideallrelatedinformationregardingdeniedclaims.
• Monitorsinsuranceauthorizationissuestoidentifytrendsandparticipatesinprocessimprovementinitiatives.
• Respondstoallinquiriesrelatedtoauthorization/pre-certificationissues.
• Developsandmaintainsknowledgeinmedicalterminology,billingandinsuranceguidelinestoensureChildren’sremainscompliantwithallregulatoryexpectations.

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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