Insurance Verifier

Join to apply for the Insurance Verifier role at Children's Healthcare of Atlanta Note: If you are currently employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Monday‑Friday Start: 8:30 AM End: 5:00 PM Worker Sub‑Type: Regular Job Description Authorizes and pre‑certifies services by coordinating and performing activities required for verification and authorization of insurance benefits. Proactively identifies resources available for families if health plan does not include coverage for services. Coordinates counseling services with Financial Counseling and ensures the standards of Surprise Billing is communicated. Collaborates with Patient Financial Services (PFS) and Managed Care department regarding denied claims. May initiate and perform revenue cycle activities required for pre‑registration. Works collaboratively with team members to provide quality service that ensures delivery of safe patient care and services. Experience At least one year of insurance verification experience Preferred Qualifications Bachelor's degree Experience in a pediatric hospital Education High school diploma or equivalent Certification Summary No professional certifications required Knowledge, Skills, And Abilities Working knowledge of basic medical terminology Demonstrated ability to multitask and problem‑solve Ability to work independently in a changing environment and handle stressful situations Must be able to speak and write in a clear and concise manner to convey messages Proficient in Microsoft Word/Excel/Outlook May require travel within Metro Atlanta as needed Job Responsibilities Conduct in‑depth account review including denial management, clinical follow‑up, and act as a liaison between clinical stakeholders and payor representation Interview patients and/or family members to secure insurance coverage, eligibility, and qualification for various financial programs Coordinate and perform verification of insurance benefits by contacting insurance provider and determining eligibility of coverage and communicate status of verification/authorization process with appropriate team members in a timely and efficient manner Provide clinical information as needed, emphasizing medical justification for procedure/service to insurance companies for completion of pre‑certification process Confirm referring physician and/or servicing physician has obtained notification/confirmation of prior authorization as needed from insurance company for all scheduled healthcare procedures within assigned department/area Contact referring physicians and/or patients to discuss rescheduling of procedures due to incomplete/partial authorizations Act as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of any possible changes, updates, responses or follow‑up; discussion points may include authorization delays, denial, pending status; answering questions regarding status changes, offering assistance, providing follow‑up steps for financial support and relaying/documenting messages pertaining to authorization of procedure/service Monitor patients on schedule, ensuring that eligibility and authorization information has been entered into data entry systems Pre‑screen doctor’s orders (scripts) received for new patients to ensure completeness/appropriateness of scheduled appointment Collaborate with Patient Financial Services (PFS) department to provide all related information regarding denied claims Monitor insurance authorization issues to identify trends and participate in process improvement initiatives Respond to all inquiries related to authorization/pre‑certification issues Develop and maintain knowledge in medical terminology, billing and insurance guidelines to ensure Children’s remains compliant with all regulatory expectations Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law. Primary Location Address: 5445 Meridian Mark Rd Job Family: Patient Access Seniority level Entry level Employment type Full‑time Job function General Business and Administrative Industries Hospitals and Health Care #J-18808-Ljbffr Children's Healthcare of Atlanta