Insurance Verification Representative (H)

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Primary Duties and Responsibilities 80% 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 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 5% 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

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.

The University of Miami is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

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