Description

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

Responsibilities:

• Search continuously for improvement opportunities and notifies eh 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 patient account to ensure acceptance of a claim
• Knowledge of insurance plans, 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.
• 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 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.
• 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 34 with renewal
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  UPMC is an Equal Opportunity Employer/Disability/Veteran

Individuals hired into this role must comply with UPMC's COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.