Insurance Verification Representative (H)

Primary Duties and Responsibilities

• Insurance Verification
• Accounts completed in a timely manner
• 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
• 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
• Mets 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
• Provides 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
• Other Duties
• Performs other duties as assigned

Knowledge, Skills and Abilities

• 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

Benefits

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