Job Posting for Insurance Verification Specialist at UAB Health System
The Insurance Verification Clerk is responsible for obtaining verification of all insurance benefits for patients prior to their scheduled surgery. This information must be maintained, prior to scheduled visit, to reflect the most up to date coverage. Performs limited data entry for new patient accounts and/or existing patient accounts. Works closely with insurance companies and clinical staff members as needed.
Has knowledge and understanding of all insurance company policies related to precertification and authorizations
Accurate verification of all insurance benefits, and entry of new or updated insurance information for all patient accounts
Works directly with multiple insurance websites for benefit and authorization validation
Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions
Responsible for timely and accurate verification of patient insurance and appropriate compliance with payer pre-certification and authorization requirements
Responsible for contacting surgery scheduler and resolving any insurance coverage issue prior to patient coming in
Responsible for noting all amounts due in patient accounts and noting any additional information needed regarding patient billing and specialty services
Works closely with Patient Accounts Representatives to place accounts On Hold if all authorization information has not been received
Required to perform certain Utilization Review clerical tasks:
Review patient census and determine status of patient during overnight admission
Fax clinical records to insurance company to authorize patient's overnight admission
Follow-up on the status of the authorization request to ensure number of days approved by patient's insurance company
Performs concurrent reviews for patients to ensure that extended stays are medically justified and are so documented in patient's medical records
Effectively and immediately communicate with Nursing Staff when authorization is not approved. (Nursing Staff will need to conduct a Peer to Peer Review with patient's insurance company for possible approval.)
Work closely with prior authorization coordinators
Uses available tools to ensure the appropriate level of benefit, pre-certification and authorization details are obtained
Must be able to effectively and willingly communicate any billing, insurance and/or estimates of payments issues to patients and schedulers as needed
Work closely with billing teams to discuss and capture up-to-date benefit coverage for surgery patients
Support billing staff in resolving any issues related to reimbursement based on coverage determination
Maintain a professional relationship with physician teams
Ensures document retention and destruction, when appropriate, in compliance with established policies and/or other applicable guidelines
Maintain patient and hospital confidentiality
Attendance and Punctuality are vital to this role
Perform all other related duties as required by Management
Preferred Skills and Education
Bachelor's degree preferred, but not required
Minimum of 1-2 years' experience in a clinical or hospital setting
Prior Insurance Verification experience in a medical office preferred
qualifications
Insurance verification experience preferred
Requires excellent telephone etiquette, computer, customer service and organizational skills
Ability to navigate numerous insurance portals to review benefit coverage details
Ability to work in a fast-paced environment
Self-motivated to work independently and collaboratively within a team environment
Ability to maintain good working relationships
Demonstrates accuracy and attention to detail
Ability to work with deadlines
Requires little supervision to accomplish tasks
Demonstrates professionalism in appearance/dress code
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