Sr. Insurance Verification Representative

Current Employees:

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The Department of Orthopedics is currently seeking a full time Senior Insurance Verification Representative to work at Soffer Clinical Research Center in Miami. The incumbent verifies insurance eligibility and authorization for all contracted and non-contracted insurance carriers and takes appropriate steps to facilitate reimbursement to department for services rendered.

Core Job Functions

• Verifies insurance information with patients for scheduled appointments and contacts payer to verify eligibility and authorization requirements.

• Adds or updates financial status classifications in appropriate systems.

• Contacts caregivers and patients for HMO payers to obtain authorizations and referrals.

• Generates and links referrals to appropriate visit once authorization is obtained. Responds to customer inquiries regarding insurance coverage of services and processing of claims.

• Follows appropriate procedures to link alternative insurance plan payers to the appropriate programs during registration.

• Identifies non-contracted HMO payers and refers to proper managing department.

• Serves as a lead Insurance Verification Representative and assists in training new staff.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

CORE QUALIFICATIONS                                                                                        

Education:

High School diploma or equivalent

Experience:

Minimum 3 years of relevant experience

Department Specific Functions

      

Insurance verification

• 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 surgery

• 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 surgery referral/authorization 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 surgery authorizations.

• Assists in educating and acts as a resource to patients, orthopedic surgeons, and surgery schedulers within the University of Miami Orthopedic department

• Contacts Primary Care Physician offices and/or Health Plan to obtain authorization or referral for scheduled surgical services according to authorization guideline listed in UHealth Contract Summary. Submits all necessary documentation required to process authorization request

• Obtains surgical authorization for all Uhealth and JMH facilities that Orthopedics operates at including satellite locations.

• Enters and attaches authorization information in referral section of Uchart for surgical procedures

• Approves referral and financially clear surgeries

• Communicates with patients and/or departments regarding authorization denial and/or re­ direction of patient by health plan or PCP office

• Contacts the surgeon and/or patient when additional information is required of them or to alert regarding pending authorization status

• Participates in process improvement initiative

Customer Service

• Provides customer service and assist patients with insurance related questions according to Orthopaedic departmental standards

• Ensures that patients are aware of issues regarding their surgery financial clearance and educated on the referral/authorization process

• Collaborates with Orthopaedics Department and operating room and Finance 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

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.

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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 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.

Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.

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 for additional information.

Job Status:

Full time

Employee Type:

Staff

Pay Grade:

H4