Current Employees:

If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here (https://www.myworkday.com/umiami/d/task/1422$7248.htmld) to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER_eRecruiting_ApplyforaJob.pdf) .

The University of Miami is currently seeking an Insurance Verification Representative to work remote. The incumbent ensures that proper insurance authorizations are processed prior to patients’ appointments to ensure a smooth and efficient visit for the patients.

CORE JOB FUNCTIONS

• Calls insurance companies and patients to verify insurance information.

• Obtains authorization for HMO patients.

• Verifies claims are mailed to the proper address.

• Contacts physicians to obtain authorizations or referrals.

• Contacts patient to obtain additional information when necessary.

• Responds to customer inquiries regarding insurance coverage for services and processing of claims.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

DEPARTMENT SPECIFIC FUNCTIONS

• Reviews EPIC WQ 1271 and WQ 1494 to determine which patient visits require authorization. (8%)

• Verifies benefits and policy limitations to determine proper coverage prior to the patient’s visit, by either sending an email to the insurance company, or calling the insurance company. (54%)

• Enters the benefits in the referral shell for the patient’s appointment, clearly noting any patient responsibility (amount of unmet deductible, co-insurance, etc.) in EPIC. (15%)

• Creates a CRM and sends it to the UHI Bundle Team when the patient has a financial responsibility, requiring a Bundled Agreement, a Deposit Agreement, a Single Case Agreement, a Deductible/Co-Pay Agreement or an Experian Estimate. (5%)

• Contacts the patient at least 24 hours in advance, if authorization for the patient’s upcoming visit has not yet been obtained. (1%)

• Provides medical records to the insurance company, when requested. (5%)

• Scans the Verification of Benefits submitted by the insurance company into Media Manager in EPIC. (3%)

• Contacts the Physician’s office to obtain a Physician Referral Form, when necessary. (2%)

• Contacts Case Management and obtains a Letter of Medical Necessity when requested by the insurance company. (1%)

• Contacts the Pricing Office to obtain “full charges” for a procedure, when requested by the insurance company. (3%)

• Contacts the patient when the insurance company states that the patient’s coverage has lapsed. (1%)

• Performs other duties as assigned. (2%)

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS

Education:

High School diploma or equivalent required

Experience:

Minimum 1 year of relevant work experience required

DEPARTMENT SPECIFIC QUALIFICATIONS

• Bilingual (English & Spanish), a plus

• Prior experience dealing with International insurance companies, a plus

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.

Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here (https://www.hr.miami.edu/careers/eo-ada/index.html) for additional information.

Job Status:

Full time

Employee Type:

Staff

Pay Grade:

H3