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The University of Miami is currently seeking a 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.
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.
CORE QUALIFICATIONS
Education:
High School diploma or equivalent
Experience:
Minimum 3 years of relevant experience
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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-sp
Location: Miami, FL
Posted: Aug. 20, 2024, 8:26 a.m.
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