Insurance Verification Representative

Why Work at Children's Hospital Colorado

Here, it’s different. Come join us.

Children's Hospital Colorado has defined and delivered pediatric healthcare excellence for more than 100 years. Here, the nation’s brightest nurses, physicians, scientists, researchers, therapists, and care providers are creating the future of child health. With an optimist’s outlook, a trailblazing spirit, and a celebrated history, we’re making new strides every day.

We’ve been Magnet-designated four times by the American Nurses Credentialing Center and are consistently recognized among the best of the best pediatric hospitals with #1 rankings in Colorado and the region by U.S. News & World Report.

As a national leader in pediatric care, we serve children and families from all over the nation. Our System of Care includes four pediatric hospitals, 11 specialty care centers, 1,300+ outreach clinics and more than 10,000 healthcare professionals representing the full spectrum of pediatric care specialties.

Here, we know it takes all of us, every role, to deliver the best possible care to each child and family we treat. That’s why we build our teams toward a foundation of equity in access, advancement, and opportunity. We know teams of individuals with different identities and backgrounds can nurture creativity and innovation. We know we can see, treat, and heal children better when our team reflects the diversity of our patient population. We strive to attract and retain diverse talent because we know a truly inclusive and equitable workforce will help us one day realize our most basic calling: to heal every child who comes through our doors.

A career at Children's Colorado will challenge you, inspire you, and motivate you to make a difference in the life of a child. Here, it’s different.

Job Overview

The Insurance Verification Rep handles high risk insurance accounts in Finance. Verifies insurance policy benefit information and obtains authorization and precertification prior to the patient's visit or non-scheduled admission.

Additional Information

Department Name: Insurance Verification
Job Status: Full time, 40 hours per week,
Shift: Day Shift 8:30 to 5pm, Hybrid

Qualifications

• EDUCATION: High School Diploma or Equivalent
• EXPERIENCE: Two years of customer service required, including one year in a medical office setting.

Responsibilities

POPULATION SPECIFIC CARE

• No direct patient care.

ESSENTIAL FUNCTIONS

• Focuses on insurance accounts identified as high risk by the department.
• Notifies insurance company of services being rendered and obtains authorization if applicable; ensures notification, authorization, and verification is completed for each account.
• Completes and obtains insurance information and referrals; verifies policy information and obtains detailed benefit information; codes work list according to departmental guidelines.
• Updates and edits coverage information on non-scheduled or pre-admitted patients.
• Assists in identifying problems; assures insurance information and appropriate referrals have been completely and accurately obtained.
• Participates in peer program development.
• Serves as a resource for co-workers and staff.
• Provides customer service in person, by phone, or email; assists customers, patients, families, providers, and staff with insurance questions or escalations.
• May work in conjunction with hospital departments to solve intradepartmental issues.
• Assists on special projects as assigned by the Supervisor.

Other Information

COMPETENCIES

• DIVERSITY & INCLUSIVITY: Is sensitive to cultural diversity, race, gender, and other individual differences in the workforce; recognizes the value of diverse perspectives and experiences and fosters a work environment reflective of the community at large.
• BUILDING CUSTOMER LOYALTY: Meeting and exceeding internal or external customer expectations while cultivating relationships that secure commitment and trust.
• BUILDING PARTNERSHIPS: Developing and leveraging relationships within and across work groups to achieve results.
• COMMUNICATION: Conveying information and ideas clearly and concisely to individuals or groups in an engaging manner that helps them understand and retain the message; listening actively to others.
• CONTINUOUS LEARNING: Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application.
• DECISION MAKING: Identifying and understanding problems and opportunities by gathering, analyzing, and interpreting quantitative and qualitative information; choosing the best course of action by establishing clear decision criteria, generating and evaluating alternatives, and making timely decisions; taking action that is consistent with available facts and constraints and optimizes probable consequences.
• EMOTIONAL INTELLIGENCE: Establishing and sustaining trusting relationships by accurately perceiving and interpreting own and others’ emotions and behavior; leveraging insights to effectively manage own responses so that one’s behavior matches one’s values and delivers intended results.
• MANAGING RELATIONSHIPS: Meeting the personal needs of individuals to build trust, encourage two-way communication, and strengthen relationships.
• PLANNING AND ORGANIZATION: Establishing an action plan for self and others to complete work efficiently and on time by setting priorities, establishing timelines, and leveraging resources.
• QUALITY ORIENTATION: Accomplishing tasks by considering all areas involved, no matter how detailed; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
• RESOLVING CONFLICT: Helping others deal effectively with an antagonistic situation to minimize damage to the relationships and promote shared goals; using appropriate interpersonal methods to reduce tension or conflict between two or more people and facilitate agreement.
• STRESS TOLERANCE: Maintaining stable performance under pressure or opposition (e.g., experiencing time pressure, conflict, or job ambiguity); handling stress in a manner that is acceptable to others and to the organization.

SCOPE AND LEVEL

• Guidelines: Guidelines are generally numerous, well established, and directly applicable to the work assignment. Work assignment and desired results are explained by general oral or written instructions.
• Complexity: Duties assigned are generally repetitive and restricted in scope but may be of substantial intricacy. Employee primarily applies standardized practices.
• Decision Making: Decisions or recommendations on non-standardized situations are limited to relating organizational policies to specific cases. Brings non-routine issues to supervisor. Problems that are not covered by guidelines or are without precedent are taken up with the supervisor.
• Communications: Contacts with the public or employees where explanatory or interpretive information is exchanged, gathered, or presented and some degree of discretion and judgment are required within the parameters of the job function.
• Supervision Received: Under normal supervision, within a standardized work situation, the employee performs duties common to the line of work without close supervision or detailed instruction. Work product is subject to continual review.

Physical Requirements

Ability to Perform Essential Functions of the Job

PHYSICAL REQUIREMENTS

• Audio-Visual: Hearing: Good
• Audio-Visual: Near Vision: Good
• General Activity: Sit: 2-4 hrs. per day
• Motion: Bend: Up to 1/3 of time
• Use of Hands/Feet: Precise Motor Function
• Weight Lifted/Force Exerted: Up to 30 pounds

WORK ENVIRONMENT

• Mental and Emotional Requirements: Independent discretion/decision making.
• Mental and Emotional Requirements: Makes decisions under pressure.
• Mental and Emotional Requirements: Manages stress appropriately.
• Mental and Emotional Requirements: Works with others effectively.