Insurance Verification Specialist - Brookfield, Wi Or National Remote

Our office is located at 2085 North Calhoun Road Brookfield, WI 53005. If you are located within commutable distance of the office, you may opt to work onsite, otherwise, you may enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Opportunities with ProHealth Care, part of the Optum family of businesses. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion, and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect, and ensures high-quality care delivery to our patients. Join us in making an impact and discover the meaning behind Caring. Connecting. Growing together.

ProHealth Care has entered into a strategic partnership with an organization called Optum with the goal of enhancing patient care, delivering innovative technology solutions, and helping ProHealth Care maintain its focus on serving patients and the community. Through this partnership, Optum will assume responsibility for ProHealth Care’s revenue cycle management, information technology, informatics, analytics, and inpatient care management. Optum was chosen as a partner to help us provide a greater scheduling experience for our patients and employees, and also because they have a similar mission to ProHealth, both focused on transforming health care for the people and communities we serve. Optum has a robust benefits package and a warm and inviting culture, just like ProHealth. We know they will serve our employees and patients well. We invite you to apply today to join this exciting partnership, where you would begin as a ProHealth Care employee and transition to an Optum employee in January 2024. Apply today to learn more.

The Insurance Verification Specialist provides detailed and timely communication in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. They ensure preauthorization and referral requirements are met prior to the delivery of system services that require authorization.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 4:30pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer weeks of on-the-job training and shadowing. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Demonstrate strong knowledge of insurance requirements including processing of all referrals requiring authorization based on plan & type of referral.
• Initiate contact w/ payers to complete Insurance Verification activities to prevent delays in care due to missing authorizations.
• Use critical thinking to troubleshoot & contact payers and patients as necessary to secure coverage & authorizations prior to services being rendered.
• Navigate EMR,insurance portals/protocols associated with each payer for authorization activities, including identifying & providing all relevant clinical information to support the authorization.
• Document all authorization related information using medical terminology appropriate to the service in the EMR to support continuity of care. Includes information gathered during the verification or authorization process.
• Update health record w/ accurate information regarding insurance coverage based on information gathered during verification &/or authorization process.
• Obtain required authorizations, pre-certifications and 2nd opinion surgical approval for inpatient/out-patient procedures for multiple service lines, depts & modalities across the continuum. Identify/escalate barriers to obtaining authorization to the insurance company or per dept protocol.
• Respond to insurance company inquiries for information. Includes consent forms, pre-authorization forms, 2nd opinion forms & referral forms.
• Coordinates w/ providers, payers, depts, & patients regarding authorization status and options & documents outcomes in the EMR.
• Confirms payment coverage including the initiation of insurance & managed care authorizations.
• Communicates w/ providers & clinical delegates to resolve any outstanding information regarding preauth & referral requirements.
• Perform electronic eligibility confirmation as needed; verify insurance for encounters & visits as assigned.
• Completes assigned tasks in EMR work queues & brings work lists to completion.
• Generates forms to insurance companies: consent , pre-authorization, second opinion and referral. Provides outcome of requested surgery/procedure order referrals to requesting MD/nurse & patient when applicable.
• Notify provider of denied procedure/request for peer to peer discussion with insurance company & adjust authorization status accordingly.
• Works independently & as part of a team in conjunction with Utilization Review/other depts as necessary to provide appropriate clinical information from the EMR in order to appeal the denials from the insurance company to secure financial payments.
• Follow-up on discharge status of patients & relay information to insurance carriers as they require.
• Actively participates in identifying/implementing improvements of department/organizational processes to more efficiently & effectively meet business objectives & educate staff as appropriate.
• Accountabilities include completion of compliance requirements, achievement of productivity standards, & maintenance of competency levels/quality standards as defined by the organization.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• 3+ years of experience in medical billing, medical Insurance Verification, managed care and / OR patient registration
• 3+ years of experience with health insurance plans including Medicare, Medicaid and commercial carriers
• 3+ years of experience working with an EMR system
• 3+ years of prior authorization experience
• 3+ years of surgical authorization experience
• Ability to work our normal business hours of 8:00am – 4:30pm CST, Monday – Friday
• Must be 18 years of age OR older

Preferred Qualifications:

• 1+ years of experience in an acute care billing / Insurance Verification / managed care / registration department
• Previous experience with prior authorizations and referrals
• Previous experience with Epic medical record and medical terminology
• Epic experience

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Consistent professional behavior and ability to handle confidential information
• Demonstrates initiative and is a self-starter
• Must demonstrate well-developed communication skills - oral and written
• Excellent customer service and relational skills
• Able to work independently, prioritizing and organizing workload effectively to complete tasks within the timeframes delegated
• Must be flexible to handle workflow demands

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.00 - $28.27 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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