Insurance Verification Representative (H)

Insurance Verification Specialist

Insurance verification accounts are completed in a timely manner in support of patient satisfaction and allow for referral and authorization activities prior to the patient's date of service. Verification of eligibility and benefits via RTE in UChart, online insurance websites, telephone or other source of automated services. Add and/or edit insurance information in UChart such as validating that the correct guarantor account and plan listed in patient's account with accurate subscriber information, policy number, and claims address and plan order. Completes the checklist and document co-pay. Creates referral if applicable, "Benefit only" or "Preauthorization", and documents benefits information: deductible, co-insurance and out of pocket benefits. Meets productivity standards for assigned work queue, QA goal of 95% or greater and maintains WQ current at 14 days out with minimum daily pending visits. Assists in educating and acts as a resource to patients, primary care and specialty care practices within the UHealth system and externally. Contacts Primary Care Physician offices and/or Health Plan to obtain authorization or referral for scheduled services according to authorization guideline listed in UHealth Contract Summary. Submits all necessary documentation required to process authorization request. Obtains authorization for both facility and provider for POS 22 and POS 19 clinics and provider only for POS 11 clinic locations. Enters and attaches authorization information in referral section of UChart. Approves referral and financially clear visits. Communicates with patients and/or departments regarding authorization denial and/or re-direction of patient by health plan or PCP office. Contacts the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status. Participates in process improvement initiatives.

Customer service and assist patients and other UHealth staff with insurance related questions according to departmental standards. Ensures that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process. Collaborates with Department and Patient Access teams to ensure that timely and concise communication occurs. Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines.

Performs other duties as assigned. Demonstrated knowledge of insurances, including authorization/referrals guidelines and requirements. Demonstrated ability to communicate effectively in written and verbal form. Bi-lingual knowledge a plus. Demonstrated ability to communicate effectively with physicians, customers, teammates and other staff. Ability to interact and assist patients of all ages, cultural background and with special needs, with a passion for providing excellent service and care. Ability to work under a high level of stress with time constraints while maintaining composure and sensitivity to each patient's specific needs. Maintain a high level of diplomacy when dealing with stressful situations. Is innovative, proactive and resourceful in problem solving.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.