Insurance Verification Representative - UHealth SoL Mia

Insurance Verification Representative

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The University of Miami UHealth at SoL Mia opening September 2025, will bring high-quality academic medicine to North Miami, Aventura, and surrounding communities. Our expert team of physicians and staff will represent a wide range of specialties, including NCIdesignated Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute, the number one eye hospital in the nation. UHealth at SoL Mia will also deliver the latest in urologic treatments from the renowned Desai Sethi Urology Institute as well as top-notch care from UHealth's nationally ranked neurology and neurosurgery programs.

Core Job Summary : The individual in this position is part of the Central Insurance Verification (CIV) department and will be responsible for supporting functions that assist in creating and driving a culture of empathy, service excellence, and delivery of patient centered care that impacts the patient experience across the UHealth System.

Our Department thrives on teamwork and collaboration, and we know our employees achieve the greatest results when they are working together for a common goal - to provide care for our patients. If you enjoy working in a collaborative environment then we have a job for you!

This position is responsible for the verification of insurance eligibility, benefits and obtaining authorization for all insurance carriers for all outpatient office visits and procedures scheduled within the UHealth Systems. The person in this position must project a positive image of the organization and department. This position directly impacts patient care, patient satisfaction and the revenue cycle. This individual reports directly to the Insurance Verification Supervisor.

Core Responsibilities :

• Accounts are completed in a timely manner in support of patient satisfaction and allow for referral and authorization activities prior to the patient's date of service
• Verification of eligibility and benefits via RTE in UChart, online insurance websites, telephone or other source of automated services
• Add and / or edit insurance information in UChart such as validating that the correct guarantor account and plan listed in patient's account with accurate subscriber information, policy number, and claims address and plan order.
• Completes the checklist and document co-pay.
• Creates referral if applicable, "Benefit only" or "Preauthorization", and documents benefits information : deductible, co-insurance and out of pocket benefits
• Meets productivity standards for assigned work queue, QA goal of 95% or greater and maintains WQ current at 14 days out with minimum daily pending visits
• Assists in educating and acts as a resource to patients, primary care and specialty care practices within the UHealth system and externally
• Contact Primary Care Physician offices and / or Health Plans to obtain authorization or referral for scheduled services according to authorization guidelines listed in UHealth Contract Summary. Submits all necessary documentation required to process authorization request
• Obtains authorization for both facility and provider for POS 22 and POS 19 clinics and provider only for POS 11 clinic locations
• Enters and attaches authorization information in referral section of UChart
• Communicates with patients and / or departments regarding authorization denial and / or re-direction of patients by health plan or PCP office
• Contact the Departments and / or patient when additional information is required of them or to alert regarding pending authorization status
• Participates in process improvement initiatives
• Provides customer service and assists patients and other UHealth staff with insurance related questions according to departmental standards
• Ensures that patients are aware of issues regarding their financial clearance and educated on the referral / authorization process
• Collaborates with Department and Patient Access teams to ensure that timely and concise communication occurs.
• Ensures service recoveries and escalations are implemented with the guidance of their supervisors and according to departmental standards and guidelines
• Performs other duties as assigned
• 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 :

Any appropriate combination of relevant education, experience and / or certifications may be considered.

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.

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 for additional information.

Job Status : Full time

Employee Type : Staff

Pay Grade : H3