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   Current UPMC employees must apply in HR Direct

Ancillary Insurance Verification Representative

  • Job ID: 950493358
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: Monday to Friday 8:00 a.m. to 4:30 p.m.
  • Shift: Day Job
  • Facility: UPMC Pinnacle Hospitals
  • Department: Central Pre-Registration
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $13.57 to $21.39 / hour

Description

Purpose:
Verifies insurance coverage and authorizations have been obtained for all scheduled ancillary services prior to date of service.

Responsibilities:
  • Search continuously for improvement opportunities and notifies the supervisor and or team leads of trends.
  • Follows up on physician office and/or patient concerns or questions.
  • Maintains knowledge of third party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker's Compensation, Auto Insurance and Managed Care contracts) and insurance compliance.
  • Refers uninsured patients, who are unable to pay, to the financial counselors.
  • Knowledge of diagnosis correlation with anatomical study scheduled. (Including contrast levels)
  • Acts as a liaison to technologists, physician offices, and other departments for scheduling and authorization directions.
  • Acts as a liaison to health center staff regarding billing questions as well as any changes health center staff need to make to a patients' account to ensure acceptance of a claim
  • Knowledge of insurance plans, UPMC Pinnacle sites participate with.
  • Knowledge of insurance contracts between hospitals.
  • Continuing education with insurance plan changes and referral/authorization guidelines
  • Educate referring physician offices on how to obtain authorizations or referrals.
  • All verification is completed daily
  • Accounts are completed in a timely manner to improve customer satisfaction and allow for referral and authorization activities prior to patient's arrival.
  • Enters authorization information onto HAR in Epic
  • Gathers and/or verifies insurance information. Resolves complex insurance verification questions.

Qualifications

  • Associate Degree or equivalent with a minimum of 1-year experience with insurance verification/authorization or closely related field. 
  • In lieu of degree a minimum of High School diploma or equivalent with 2-3 years' experience with insurance verification/authorization or closely related field.
  • Working knowledge of basic medical terminology and completion of medical terminology course within six months of employment with passing score of 80%.
  • Excellent verbal and written communication skills. 
  • Working knowledge of insurance/billing requirements preferred.
  • Prior Epic knowledge preferred.
  • ICD-10 coding knowledge preferred.
  • CPT codes for diagnostics procedures.

Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days

  • Act 33 with renewal
  • Act 34 with renewal
  • Act 73 FBI Clearance with renewal

  • UPMC is an Equal Opportunity Employer/Disability/Veteran

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       Current UPMC employees must apply in HR Direct

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