Work Schedule/Days: Day / Monday – Friday
Employment Type: Full-Time
Location: Medical Office Building
Requisition #: 82483
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.
- High school diploma or equivalent
- No professional certifications required
- Completion of an externship approved by Children’s or one year of experience in insurance verification or an assigned clinical discipline
- 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
- 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.
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.
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)
Some potential for exposure to blood and body fluids
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, 20 neighborhood locations and a total of 673 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 60 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 recognized as a Fortune 100 Best Place to Work, a Best Place for Working Mothers, and as a top employer for diversity and millennials. 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 What to Expect.
Address: 5461 Meridian Mark, Atlanta, GA 30342
Function: Revenue Cycle – Patient Financial Services