Surgical Insurance Verification Representative

Purpose:

Do you have experience with medical insurance?  UPMC is looking to hire full-time Surgical Insurance Verification Representatives.  Although not common, flexible full-time and part-time positions are occasionally available.  This position would work Monday through Friday during daylight hours.  The position is located at the Southgate Building in Harrisburg.

The Surgical Insurance Verification Representative creates the hospital account in EPIC and verifies insurance coverage and authorizations have been obtained for all scheduled inpatient and short procedure surgery cases prior to date of service.

If you have experience with insurance verifications and authorizations, especially surgical procedures, and this position sound like a good fit for you, apply today!

Responsibilities:

• Enter authorization information into Hospital Account in EPIC.
• Follow up on patient and Physician office concerns or questions.
• Incorporate new policies and procedures into daily responsibilities and ask supervisor questions when clarification is needed.
• Maintain knowledge of third-party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker’s Compensation, Auto Insurance, and Managed Care contracts) and insurance compliance.
• Make recommendations for improving department systems, policies, and procedures.
• Create hospital account records for all surgical cases. Complete accounts in a timely manner to improve customer satisfaction and allow for referral and authorization prior to patient’s arrival.
• Educate referring Physician offices on authorization/referral requirements for surgical procedures.
• Perform all other duties as assigned or deemed necessary in the department’s mission to serve patients.
• Review all inpatient and short procedure surgery accounts for completion of registration and insurance data. Revise registration with correct insurance, demographics, and guarantor information as necessary.
• Resolve complex insurance verification questions.
• Maintain working knowledge of insurance plans participating with UPMC Pinnacle.
• Act as a liaison regarding billing questions as well as any changes staff need to make to a patient’s account to ensure acceptance of a claim.