Purpose:

Do you have experience with medical insurance? UPMC is looking to hire full-time Ancillary 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 Ancillary Insurance Verification Representative verifies that insurance coverage and authorizations have been obtained for all scheduled ancillary services prior to date of service.

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

Responsibilities:

• Search continuously for improvement opportunities and notify the supervisor and/or team leads of trends.

• Follow up on physician office and/or patient concerns or questions.

• 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.

• Refer uninsured patients, who are unable to pay, to the financial counselors.

• Knowledge of diagnosis correlation with anatomical study scheduled. (Including contrast levels)

• Act as a liaison to technologists, physician offices, and other departments for scheduling and authorization directions.

• Act 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 that UPMC Pinnacle sites participate with.

• Knowledge of insurance contracts with Tristan locations.

• Knowledge of the different protocols between facilities and Radiology groups.

• Continuing education with insurance plan changes and referral/authorization guidelines

• Educate referring physician offices on how to obtain authorizations or referrals.

• Ensure all verification is completed daily.

• Ensure accounts are completed in a timely manner to improve customer satisfaction and allow for referral and authorization activities prior to patients' arrival.

• Enter authorization information onto HAR in Epic

• Gather and/or verify insurance information.

• Resolve complex insurance verification questions.

• Associates Degree or equivalent with a minimum of 1 year of experience with insurance verification/authorization or a closely related field. In lieu of a degree, a minimum of a High School diploma or equivalent with 2-3 years of experience with insurance verification/authorization or a 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.

• Prior Epic knowledge preferred.

• ICD-10 coding knowledge preferred.

• Knowledge of CPT codes for diagnostics procedures preferred.

Licensure, Certifications, and Clearances:

Clearances must be dated within 90 days.

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran