Description:
INSURANCE VERIFICATION SUPERVISOR
Location: Burnet Campus, 3430 Burnet Avenue, Cincinnati OH 45224
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.
Cincinnati Children's Hospital Has Been Named:
· #1 Children’s Hospital in the Nation by US News and World Report 2023
· Ranked #1 in the Nation and Top 10 in All Specialties
· One of nation’s Best Employers for Women by Forbes, July 2024
· #2 recipient of pediatric research grants from the National Institutes of Health
· Ranked among nation’s Best Employers for Diversity by Forbes
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 that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members. 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
Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary. Responsible for research, analysis and resolution of complex issues and questions. Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes.
·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. Participate in Department Meetings to share payer trends related to Pre-Authorizations.
·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. Assign tasks to the appropriate shill level as needed to ensure efficiency and productivity.
·Coordination
Serve as an internal and external resource/expert for health insurance questions from customers/clients. Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff. Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources. Working knowledge and functions of multiple divisions. Complete retrospective authorizations when necessary.
Expected Starting Salary Range: 24.68 - 30.29
Qualifications:
EDUCATION/EXPERIENCE
Required:· High school diploma or equivalent
·7+ years of work experience in a related job discipline.
Preferred:Certified Professional Coder
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. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/AA/M/F/Veteran/Disability