Job Details

Insurance Verification Representative

The University of Miami/UHealth Central Business Office has an exciting opportunity for a full-time Insurance Verification Representative to work remotely.

Core responsibilities include:

• Completing accounts in a timely manner in support of patient satisfaction and allowing for referral and authorization activities prior to the patient's date of service.
• Verifying eligibility and benefits via RTE in UChart, online insurance websites, telephone or other source of automated services.
• Adding and/or editing 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.
• Completing the checklist and document co-pay.
• Creating referral if applicable, "Benefit only" or "Preauthorization", and documenting benefits information: deductible, co-insurance and out of pocket benefits.
• Meeting productivity standards for assigned work queue, QA goal of 95% or greater and maintaining WQ current at 14 days out with minimum daily pending visits.
• Assisting in educating and acting as a resource to patients, primary care and specialty care practices within the UHealth system and externally.
• Contacting 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. Submitting all necessary documentation required to process authorization request.
• Obtaining authorization for both facility and provider for POS 22 and POS 19 clinics and provider only for POS 11 clinic locations.
• Entering and attaching authorization information in referral section of UChart.
• Approving referral and financially clearing visits.
• Communicating with patients and/or departments regarding authorization denial and/or re-direction of patients by health plan or PCP office.
• Contacting the Departments and/or patient when additional information is required of them or to alert regarding pending authorization status.
• Participating in process improvement initiatives.
• Providing customer service and assisting patients and other UHealth staff with insurance related questions according to departmental standards.
• Ensuring that patients are aware of issues regarding their financial clearance and educated on the referral/authorization process.
• Collaborating with Department and Patient Access teams to ensure that timely and concise communication occurs.
• Ensuring service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines.
• Performing 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 include:

• 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.

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