Role Description

The Insurance Verification Specialist provides detailed and timely communication to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization.

The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home. Our office is located at 2085 North Calhoun Road Brookfield, WI 53005. If you are located within commutable distance of the office, you may opt to work onsite; otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S.

Primary Responsibilities:

• Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral.
• Initiate contact with payers to complete insurance verification activities to prevent delays in care due to missing authorizations.
• Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered.
• Navigate EMR, insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization.
• Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care.
• Update health record with accurate information regarding insurance coverage based on information gathered during verification &/or authorization process.
• Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, departments & modalities across the continuum.
• Identify/escalate barriers to obtaining authorization to the insurance company or per department protocol.
• Respond to insurance company inquiries for information, including consent forms, pre-authorization forms, 2nd opinion forms & referral forms.
• Coordinate with providers, payers, departments, & patients regarding authorization status and options & document outcomes in the EMR.
• Confirm payment coverage including the initiation of insurance & managed care authorizations.
• Communicate with providers & clinical delegates to resolve any outstanding information regarding pre-authorization & referral requirements.
• Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits as assigned.
• Complete assigned tasks in EMR work queues & bring work lists to completion.
• Generate forms to insurance companies: consent, pre-authorization, second opinion and referral.
• Provide outcome of requested surgery/procedure order referrals to requesting MD/nurse & patient when applicable.
• Notify provider of denied procedure/request for peer-to-peer discussion with insurance company & adjust authorization status accordingly.
• Work independently & as part of a team in conjunction with Utilization Review/other departments as necessary to provide appropriate clinical information from the EMR to appeal the denials from the insurance company.
• Follow up on discharge status of patients & relay information to insurance carriers as they require.
• Actively participate in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriate.
• Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization.

Qualifications

• High School Diploma/GED
• 1+ years of experience in medical billing, medical insurance verification, managed care and/or patient registration
• 1+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers
• 1+ years of experience working with an EMR system
• 1+ years of experience working with pharmacy/medication prior authorizations
• Intermediate level of proficiency with Microsoft Office products
• Must be 18 years of age or older

Requirements

• 1+ years of experience in an acute care billing/insurance verification/managed care/registration department (preferred)
• Previous experience with prior authorizations and referrals (preferred)
• Previous experience with Epic medical record and medical terminology (preferred)
• Epic experience (preferred)

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Must have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills

• Consistent professional behavior and ability to handle confidential information
• Demonstrates initiative and is a self-starter
• Must demonstrate well-developed communication skills - oral and written
• Excellent customer service and relational skills
• Able to work independently, prioritizing and organizing workload effectively to complete tasks within the timeframes delegated
• Must be flexible to handle workflow demands

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.