Insurance Verification Representative (H)

Current Employees:

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The University of Miami/UHealth Central Business Office has an exciting opportunity for a full-time Insurance Verification Representative to work in Miami, FL. T he 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. Our Department thrives on t eamwork and collaboration, and we know our employees achieve the greatest results when they are working together for a common goal – to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you! This po sition is responsible for the verification of insurance eligibility , benefits and obtaining authorization for all in surance carriers for all outpatient office visits and procedures scheduled within the UHealth Systems. The person in this position must proj ect 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 .

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 2

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 15% 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

Performs other duties as assigned

Minimum Qualifications (Essential Requirements):

High School Diploma or equivalent

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

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

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

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

UHealth-University of Miami Health System, South Floridas 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. Were the challenge youve been looking for.

The University of Miami is an Equal Opportunity Employer – Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here (https://www.hr.miami.edu/careers/eo-ada/index.html) for additional information.

Job Status:

Full time

Employee Type:

Staff

Pay Grade:

H3