Description

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

This position will work 8-hour shifts Monday to Friday, during one of the following: 7:30 a.m. to 4:00 p.m. or 8:00 a.m. to 4:30 p.m. The shift will be determined at the time of hire. Strong preference given to applicants who have graduated from a Medical Assistant program and previous experience with insurance authorization.

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.
• 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's 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
  • Strong preference given to applicants who have graduated from a Medical Assistant program and previous experience with insurance authorization.

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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