Insurance Verification Representative I

Description
Expected Starting Salary Range: 16.98 - 20.43
SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
REPRESENTATIVE RESPONSIBILITIES

• Pre-Authorization

Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications. Collaborate with internal and external resources regarding specific authorizations scenarios. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.

• Problem Resolution

Initiate calls to appropriate parties both internal and external to resolve issues. Escalate to appropriate staff regarding system errors, recurring divisional problems/errors identified within work queues or reports.

• Collaboration

Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions.

• Productivity

Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems.
Qualifications
EDUCATION/EXPERIENCE
Required:

• High school diploma or equivalent
• No directly related experience

Preferred:
Unique Skills:
Cincinnati Children's is proud to be an Equal Opportunity Employer that values and treasures Diversity, Equity, and Inclusion. We are committed to creating an environment of dignity and respect for all our employees, patients, and families (EEO/AA).