Job Details

Insurance Verification Representative

The University of Miami/UHealth Central Business Office - UHealth SoLé Mia has an exciting opportunity for a full-time Insurance Verification Representative to work remotely. The individual in this position is part of the Central Insurance Verification (CIV) department and will be responsible for supporting functions that assist in creating and driving a culture of empathy, service excellence and delivery of patient centered care that impacts the patient experience across the UHealth System. This position is responsible for the verification of insurance eligibility, benefits and obtaining authorization for all insurance carriers for all outpatient office visits and procedures scheduled within the UHealth Systems. The person in this position must project a positive image of the organization and department. This position directly impacts patient care, patient satisfaction and the revenue cycle. This individual reports directly to the Insurance Verification Supervisor.

CORE RESPONSIBILITIES

• 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
• Contact Primary Care Physician offices and/or Health Plans to obtain authorization or referral for scheduled services according to authorization guidelines 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
• Communicates with patients and/or departments regarding authorization denial and/or re-direction of patients by health plan or PCP office
• Contact the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status
• Participates in process improvement initiatives
• Provides customer service and assists 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
• This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS

• High School Diploma or equivalent
• Minimum 1 year of relevant work experience
• Computer literate (EPIC scheduling and registration application experience a plus).
• Strong written and oral communication skills.
• Able to work in a team environment.
• Graceful under pressure and stressful situations
• Demonstrated knowledge of insurance, including authorization/referral 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 backgrounds 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.

Any appropriate combination of relevant education, experience and/or certifications may be considered.

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