Insurance Verification Representative

Job Description

At Cincinnati Childrens, we come to work with one goal: to make childrens health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Childrens.

Cincinnati Childrens is:

• Recognized by U.S. News & World Report as a top 10 best childrens hospitals in the nation for more than 15 years
• Second Among All Childrens Hospitals for National Institutes of Health (NIH) Funding
• Recognized as one of Americas Best Large Employers (2025) , Americas Best Employers for New Grads (2024)
• One of the nations Americas Most Innovative Companies as noted by Fortune
• Consistently certified as great place to work
• A Leading Disability Employer as noted by the National Organization on Disability
• Magnet® designated for the fourth consecutive time by the American Nurses Credentialing Center (ANCC)

JOB RESPONSIBILITIES

• Pre-Authorization -Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.

• Problem Resolution -Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary. Responsible for research, analysis and resolution of complex issues and questions. Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes.

• Collaboration -Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Childrens departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions. Participate in Department Meetings to share payer trends related to Pre-Authorizations.

• Productivity -Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Assign tasks to the appropriate shill level as needed to ensure efficiency and productivity.

• Coordination -Serve as an internal and external resource/expert for health insurance questions from customers/clients. Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff. Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources. Working knowledge and functions of multiple divisions. Complete retrospective authorizations when necessary.

JOB QUALIFICATIONS

• High school diploma or equivalent

• 3+ years of work experience in a related job discipline

Market Leading Benefits Including*:

• Medical coverage starting day 1 of employment.

• Competitive retirement plans

• Tuition reimbursement for continuing education

• Expansive employee discount programs through our many community partners

• Shift Differential, Weekend Differential, and Weekend Option Pay Programs

• Referral bonus program for current staff!

• Support through Employee Resource Groups such as African American Professionals Advisory Council, Asian Cultural and Professional Group, EQUAL - LGBTQA Resource Group, Juntos - Hispanic/Latin Resource Group, Veterans and Military Family Advocacy Network, and Young Professionals (YP) Resource Group

• Physical and mental health wellness programs

• Relocation assistance available for qualified positions

• Benefits may vary based on FTE Status and Position Type

Primary Location

Schedule

Shift

Department

Employee Status

FTE

Weekly Hours

• Expected Starting Pay Range
• Annualized pay may vary based on FTE status

Comprehensive job description provided upon request.

Cincinnati Childrens is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability

Information :

• Company : Cincinnati Children's Hospital
• Position : Insurance Verification Representative
• Location : Cincinnati, OH
• Country : US