Sr. Insurance Verification Representative (H)

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The University of Miami/UHealth Central Business Office has an exciting opportunity for a full-time Sr. Insurance Verification Representative to work remotely.  The individual in this position is part of the Central Insurance Verification (CIV) departmentand 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 teamwork 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 position is responsible for the verification of insurance eligibility, benefitsand 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 therevenue cycle. This individualreports directly tothe Insurance Verification Supervisor.

Primary Duties and Responsibilities

• 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 service

• 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 w