Insurance Verification Specialist

Shriners Children's Insurance Verification Specialist

Shriners Children's is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

With 20+ hospitals, outpatient clinics, ambulatory care centers and outreach locations across the globe, we provide excellent care to children up to age 18 regardless of their family's ability to pay or insurance status.

Under the leadership of the Billing and Contracts Manager, the POPS Insurance Verification Specialist is an active member of the O&P Billing Team who delivers support that is consistent with the strategic vision, goals, philosophy and direction of Shriners Children's organization and POPS (Pediatric Orthotic and Prosthetic Services). The Specialist is responsible for determining the status of a patient's insurance eligibility/coverage by contacting the appropriate insurance or third party payor in accordance with POPS policies and procedures. The Specialist will have a thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid and Medicare payor guidelines and eligibility criteria. The Patient Insurance Specialist will physically be located remotely, but perform insurance verification for assigned hospitals located throughout the country.

This is a 100% onsite position at our Corporate Headquarters in Tampa, FL.

Key Responsibilities:

• Updates OPIE with the appropriate eligibility and COB status.
• Documents in the health plan comment field on the encounter all actions that have been taken on the account related to insurance verification and authorization
• Updates health plans as needed based on feedback from the insurance company.
• Maintains a detailed level of knowledge of all payors authorization/referral guidelines and update all appropriate fields in OPIE.
• Maintains a productivity log on a daily basis
• Coordinates and prioritizes assigned activities to achieve maximum productivity
• Completes special projects as directed by the Manager of Patient Access.
• Responds positively to necessary changes in the workplace
• Attend workshops and seminars, read manuals and updates to maintain a high level of knowledge of all payor criteria
• Maintains professional competency, according to department policies, procedures and protocols

Required Qualifications:

• 3 Years Insurance prior-authorization in a medical office and/or hospital setting
• MS Office Suite
• High School Diploma/GED

Preferred Qualifications:

• Durable Medical Equipment experience

Compensation is determined based on years of relevant experience and departmental equity.