[Hiring] Senior Insurance Verification Representative @University of Miami

Role Description

• Works in collaboration with supervisory team to assist in the training of new hires and coaching of team members.
• 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-pays.
• Creates referral, “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.
• Initiates educating and acting 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 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. Provides exemplary customer service and assist patients and other UHealth staff with insurance related questions.
• Initiates, identifies, and tests process improvement opportunities, including, but not limited to, participating in project teams.
• Provides exemplary customer service and assist patients and other UHealth staff with insurance related questions.
• Ensures that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process.
• Initiates collaboration with Department, Patient Access, and related stakeholders to ensure that timely and concise communication occurs.
• Demonstrates a high-level ability to solve difficult situations without supervisory intervention.
• Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines, provides feedback, and confirms mid to long term resolutions.
• Performs other duties as assigned.

Benefits

• Competitive salaries.
• Comprehensive benefits package including medical, dental, tuition remission and more.

Company Description

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status

Full time

Employee Type

Staff