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Work Shift

Day

Work Day(s)

Monday-Friday

Shift Start Time

8:00 AM

Shift End Time

5:00 PM

Worker Sub-Type

Regular

Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.

Job Description

Serves as expert/senior team member while participating in authorization and pre-certification of healthcare services to prevent claims denial and/or appointment cancellation/rescheduling due to authorization issues (e.g., ensuring referring physician obtains prior authorization from insurance company for all scheduled healthcare procedures within assigned department/area). Provides ongoing communication and training to physician offices, patients/families, and others to resolve authorization- related departmental issues. Coordinates changes in process and provides learning materials and resources. Proactively identifies and communicates financial resources available if health plan does not include coverage for services. Coordinates counseling services with Financial Counseling. Collaborates with Patient Financial Services (PFS) department regarding denied claims. Initiates and performs revenue cycle activities required for insurance verification, authorization, and pre-registration. Works collaboratively with team members to provide quality service. Supports the leadership team as needed.

Experience

3 years of healthcare insurance verification experience, including authorizationsEpic experience

Preferred Qualifications

Bachelor's degreeExperience in a pediatric hospitalEpic SuperUser

Education

High school diploma or equivalent

Certification Summary

Certified Healthcare Access Associate Certification (CHAA) within six (6) months of employment as Senior Insurance Verifier

Knowledge, Skills, and Abilities

Working knowledge of medical terminologyDemonstrated ability to multitask and problem-solveAbility to work independently in a changing environment and handle stressful situations.Ability to read, analyze and interpret medical and supply publications, technical procedures and/or training toolsWhen applicable, specialized focus on assignment or location, must be able to analyze in depth account review including but not limited to, denial management, clinical follow up, and act as a liaison between clinical stakeholders and payor representationExcellent verbal and written communication skillsMay require travel within Metro Atlanta as neededMust be able to speak and write in a clear and concise manner to convey messagesProficient in Microsoft Word/Excel/OutlookKnowledge of Availity, MMIS and insurance payer websites

Job Responsibilities

Assists Management Team with quality assurance, productivity monitoring and monthly reporting.Performs daily quality audits to ensure all healthcare services are authorized and documented accurately and timely.Conducts in depth account review including but not limited to, denial management, clinical follow up, and acts as a liaison between clinical stakeholders and payor representation.Interviews patients and/or family members to secure 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 and/or servicing physician has obtained notification/confirmation of 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 any possible changes, updates, responses or follow up. Discussion points may include the following: authorization delays, authorization denials, pending status, answering questions regarding status changes, offering assistance, providing follow up steps for financial support and relaying/documenting messages pertaining to authorization of procedure/service.Monitors patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems.Depending on payer, pre-screens new patient doctor’s orders (scripts) to ensure completeness/appropriateness of scheduled appointment.Collaborates with Patient Financial Services (PFS) department to provide all related information regarding denied claims.Monitors insurance authorization issues to identify trends and participates in process improvement initiatives.Responds to all inquiries within the system and outside related to authorization/pre-certification issues.Develops and maintains knowledge in medical terminology, billing and insurance guidelines to ensure Children’s remains compliant with all regulatory expectations.Will assist with training, shadowing, and quality assurance for new employees.

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Patient Access