Senior Insurance Verifier

Job Title: Senior Insurance Verifier Serves as an expert/senior team member while participating in authorization and pre‑certification of healthcare services to prevent claims denial and/or appointment cancellation/rescheduling due to authorization issues. Provides ongoing communication and training to physician offices, patients/families, and other stakeholders to resolve authorization‑related departmental issues. Coordinates changes in process, provides learning materials and resources, and proactively identifies and communicates financial resources available when health plans do not include coverage for services. Shift Details Days: Friday, Monday, Thursday, Tuesday, Wednesday. Shift Start Time: 8:00 AM. Shift End Time: 4:30 PM. Worker Sub‑Type: Regular. Responsibilities Perform insurance verification, authorization, and pre‑registration activities. Conduct daily quality audits to ensure all healthcare services are authorized and documented accurately and timely. Interview patients and/or family members to secure insurance coverage, eligibility, and qualification for financial programs. Coordinate and perform verification of insurance benefits by contacting providers and determining eligibility of coverage. Provide clinical justification for procedures/services to insurance companies to complete pre‑certification. Confirm referring or servicing physicians have obtained prior authorization for scheduled procedures. Act as liaison among clinical staff, patients, referring physicians, and insurance providers, communicating status updates and required follow‑ups. Monitor patients on schedule, ensuring eligibility and authorization information is entered into data systems. Collaborate with Patient Financial Services to provide information regarding denied claims. Identify trends in authorization issues and participate in process improvement initiatives. Respond to all inquiries within the system and externally related to authorization/pre‑certification. Develop and maintain knowledge in medical terminology, billing, and insurance guidelines for compliance. Assist with training, shadowing, and quality assurance for new employees. Qualifications Minimum 3 years of healthcare insurance verification experience, including authorizations. Epic experience. Bachelor’s degree (preferred). High school diploma or equivalent. Certified Healthcare Access Associate (CHAA) within six (6) months of employment as Senior Insurance Verifier. Preferred Qualifications Epic SuperUser. Knowledge, Skills, and Abilities Working knowledge of medical terminology. Demonstrated ability to multitask and problem‑solve. Ability to work independently in a changing environment and handle stressful situations. Ability to read, analyze, and interpret medical & supply publications, technical procedures, and training tools. Specialized focus on assignment or location, with depth in account review including denial management and clinical follow‑up. Effective verbal and written communication skills. Proficiency in Microsoft Word, Excel, Outlook. Knowledge of Availity, MMIS, and insurance payer websites. EEO Statement 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. #J-18808-Ljbffr Dormont Manufacturing Co