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Senior Ancillary Insurance Verification Representative

  • Job ID: 239184364
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8 a.m. to 4:30 p.m.
  • Shift: Day Job
  • Facility: Pinnacle Health Support Services
  • Department: Patient Access
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $17.52 to $26.27 / hour

Description

Purpose:
Acts as a resource for all Patient Access areas. Acts as a relief person for all insurance verification positions. Oversees the flow of work within the department in the absence of the Manager. Performs all essential duties of the Ancillary/Surgical Insurance Verification Representative.

Responsibilities:

  • Performs all other duties as assigned or deemed necessary in the department's mission to serve patients.
  • Must be able to communicate clearly with patients, physician offices, and other staff in an assertive but not aggressive manner to ensure authorizations are in place for payment. Interacts with staff, patients and their families if necessary.
  • Adheres to Universal Standards and Compliance issues.
  • Incorporates new policies and procedures into daily responsibilities and asks supervisor questions when clarification is needed.
  • Makes recommendations for improving department systems, policies and procedures.
  • Follows up on physician office and/or patient concerns or questions.
  • Maintains working 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 regarding billing questions as well as any changes staff need to make to a patients? account to ensure acceptance of a claim.
  • Maintains working knowledge of insurance plans, UPMC Pinnacle participates with.
  • Maintains working knowledge of specialized insurance contracts specific to Tristan Imaging locations.
  • Maintains working knowledge of the different protocols between facilities and Radiology groups.
  • Maintains working knowledge of third party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker's Compensation, Auto Insurance and Managed Care contracts) and insurance compliance.
  • Continuing education with insurance plan changes and referral/authorization guidelines.
  • Acts as a resource for all departments that need assistance or answering insurance verification queries / concerns.
  • Conducts follow up training to meet QA compliance.
  • Performs QA on assigned staff to ensure accuracy of insurance verification process and to update individual staff goal results in Success Factors.
  • Performs QA on new hires for the ancillary pre-arrival area to ensure understanding and the accuracy of the insurance verification process.
  • Acts as preceptor for all new staff within the ancillary pre-arrival area.
  • Identifies problems/concerns and refers them to Manager for action.
  • Prioritizes and oversees workflow of ancillary insurance verifiers.
  • Acts as resource for co-workers to obtain assistance and knowledge of complex situations.

 

Qualifications

  • Associate Degree or equivalent with a minimum of 1 year experience with insurance verification/authorization OR 3 years' experience with insurance verification/authorization.
  • 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.
  • Strong customer service orientation.
  • Working knowledge of insurance / billing requirements.
  • Preferred Knowledge:
    • Skills and Abilities:
      • 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