Insurance Verification Representative (H)

Responsibilities

• Insurance Verification (80%)
  • Complete accounts timely to support patient satisfaction and allow referral/authorization prior to service date.
  • Verify eligibility and benefits via RTE in UChart, online insurance websites, telephone or automated sources.
  • Add/edit insurance info in UChart: correct guarantor, plan, subscriber details, policy number, claims address, plan order.
  • Complete checklist and document co‑pay; create referral if applicable and document benefit details: deductible, co‑insurance, out‑of‑pocket benefits.
  • Meet productivity standards: QA goal ≥ 95%, maintain WQ current 14 days out, minimum daily pending visits.
  • Educate and serve as resource to patients and practices within UHealth system and externally.
  • Contact primary care or health plan to obtain authorization/referral for scheduled services per UHealth contract guidelines.
  • Submit all required documentation for authorization requests.
  • Obtain authorization for facility and provider for POS 22 and POS 19 clinics and provider only for POS 11 clinic locations.
  • Enter and attach authorization info in referral section of UChart.
  • Approve referral and ensure financial clearance of visits.
  • Communicate with patients/departments regarding denial or redirection by health plan or PCP office.
  • Contact departments/patients for additional information or to update pending authorization status.
  • Participate in process improvement initiatives.
• Customer Service (15%)
  • Provide customer service and assist patients and staff with insurance related questions.
  • Ensure patients aware of financial clearance issues and educate on referral/authorization process.
  • Collaborate with Department and Patient Access teams for timely communication.
  • Implement service recoveries and escalations under supervisor guidance per departmental standards.
• Other Duties (5%)
  • Perform other duties as assigned.

Qualifications and Skills

• Knowledge of insurance, including authorization/referral guidelines and requirements.
• Effective communication – written and verbal.
• Bi‑lingual knowledge a plus.
• Ability to communicate effectively with physicians, customers, teammates and staff.
• Ability to assist patients of all ages, cultural backgrounds and special needs with a passion for excellent service and care.
• Ability to work under high stress with time constraints while maintaining composure and sensitivity to patient needs.
• Diplomacy in stressful situations.
• Innovative, proactive, resourceful in problem solving.

Benefits

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System is an Equal Opportunity Employer. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

Job Status: Full time

Employee Type: Staff