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Insurance Verifier - CPG Orthopaedics - Office Park

Insurance Verifier - CPG Orthopaedics - Office Park Work Schedule/Days: Day / Mo

2019-06-12 2020
Children’s Healthcare of Atlanta
Position: Verifier Salary: Unspecified Type: Full Time Location: Atlanta, GA
Work Schedule/Days: Day / Monday - Friday
Employment Type: Full-Time
Location: Office Park (1644)
Requisition #: 33450
JOB SUMMARY
Authorizes and pre-certifies services by coordinating and performing activities required for verification and authorization of
insurance benefits for services. Proactively identifies resources for patients and may communicate with families the
financial resources available to patients whose health plan does not include coverage for services, coordinating counseling
services with Financial Counseling as required. Collaborates with Appeals department to overturn claims denied as well as
Managed Care department in contract negotiations. May initiate and perform revenue cycle activities required for pre-
registration. Works collaboratively with team members to provide quality service to proactively support efforts that ensure
delivery of safe patient care and services and promote a safe environment at Children’s Healthcare of Atlanta.
EDUCATION
High school diploma or equivalent
CERTIFICATION SUMMARY
No professional certifications required
EXPERIENCE*
Completion of an externship approved by Children’s or one year of experience in insurance verification or an assigned
clinical discipline
PREFERRED QUALIFICATIONS*
Bachelor’s degree
Experience in a pediatric hospital
KNOWLEDGE SKILLS & ABILITIES*
Working knowledge of basic medical terminology
Demonstrated multitasking and problem-solving skills
Ability to work independently in a changing environment and handle stressful situations
Must pass typing test with at least 50 words per minute
Demonstrated arithmetic and word mathematical problem-solving skills
Must be able to speak and write in a clear and concise manner to convey messages and ensure that the customer
understands whether clinical or non-clinical
Proficient in Microsoft Word/Excel/Outlook, SMS, Epic, CSC Papers, scheduling systems (e.g., NueMD, RIS, SIS), IMS Web,
Report Web, and insurance websites (e.g., BCBS, RADMD, WebMD, Wellcare, Amerigroup, UHC)
Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating
May require travel within Metro Atlanta as needed
Strives for adult-to-adult relationships with colleagues, subordinates, and superiors
JOB RESPONSIBILITIES*
Interviews patients and/or family members as needed to secure information concerning insurance coverage, eligibility, and
qualification for various financial programs.
Coordinates and performs verification of insurance benefits by contacting insurance provider and determining eligibility of
coverage and communicates status of verification/authorization process with appropriate team members in a timely and
efficient manner.
Provides clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for
completion of pre-certification process.
Confirms referring physician has obtained prior authorization as needed from insurance company for all scheduled
healthcare procedures within assigned department/area.
Contacts referring physicians and or/patients to discuss rescheduling of procedures due to incomplete/partial
authorizations.
Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families
of authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to
authorization of procedure/service.
Maintains tracking of patients on schedule, ensuring that eligibility and authorization information has been entered into
data entry systems.
Pre-screens doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled
appointment.
Collaborates with Appeals department to provide all related information to overturn claims denied.
Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.
Responds to all inquiries from throughout the system and outside related to authorization/pre-certification issues.
Provides ongoing communication to physician offices, patients/families, and others as necessary to resolve insurance
authorization issues.
SYSTEM RESPONSIBILITIES*
Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures.
Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and
in the occurrence notification system.
Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and
procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem
resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.
The above statements are intended to describe the general nature and level of work performed by people assigned to this
classification. They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.
PHYSICAL DEMANDS*
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping - Occasionally (activity or condition exists up to 1/3 of time)
Climbing - Occasionally (activity or condition exists up to 1/3 of time)
Hearing/Speaking - Effective communication with employees, supervisors/managers and staff. Effective communications
with patients and visitors, as required.
Lifting - Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling - Occasionally (activity or condition exists up to 1/3 of time)
Sitting - Frequently (activity or condition exists from 1/3 to 2/3 of time)
Standing - Occasionally (activity or condition exists up to 1/3 of time)
Walking - Occasionally (activity or condition exists up to 1/3 of time)
WORKING CONDITIONS*
Some potential for exposure to blood and body fluids
About Us:
Children’s Healthcare of Atlanta has been 100 percent committed to kids for more than 100 years. A not-for-profit
organization, Children’s is dedicated to making kids better today and healthier tomorrow.
With 3 hospitals, 27 neighborhood locations and a total of 638 beds, Children’s is the largest healthcare provider for
children in Georgia and one of the largest pediatric clinical care providers in the country. Children’s offers access to more
than 70 pediatric specialties and programs and is ranked among the top children’s hospitals in the country by U.S. News &
World Report.
Children’s has been ranked on Fortune magazine’s list of “100 Best Companies to Work For” for fourteen consecutive years
and named one of the “100 Best Companies” by Working Mother magazine. We offer a comprehensive compensation and
benefit package that supports our mission, vision and values. We are proud to offer an array of programs and services to
our employees that have distinguished us as a best place to work in the country. Connect to our mission of making kids
better today and healthier tomorrow.
Have questions about the recruitment process? Check out .
Address: 1644 Tullie Circle, Atlanta, GA 30329
Function: Revenue Cycle - Patient Financial Services
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