Penn Medicine, University of Pennsylvania Health System · 1 month ago
Team Lead Insurance Verification - Full Time
Lawrenceville, NJ
Full-time
Onsite
Mid Level
$19.97/hr - $31.81/hr
3+ years expPenn Medicine is dedicated to providing high-quality patient care, conducting innovative research, and educating future leaders in medicine. The Team Lead will assist the Insurance Verification Manager in daily operations while performing standard duties of an Insurance Verification Analyst.
BiotechnologyEducationHealth CareMedicalTraining
Responsibilities
Support the department workflow to ensure quality standards are met by maintaining and distributing daily assignments based on incoming workloads and staff availability. Monitors WQs to make real time adjustments as necessary and act as a key backup for any gaps in staffing
Assists IV team with any day-to-day issues, tracks backlog and unresolved issues to report to IV Manager and acts as a clearinghouse for questions and issues, before escalating to Manager
Acts as a training resource for new staff and a resource for co-workers, sharing processes and workflow information
Assists IV Manager in monitoring verification Work Queues, days-out and registration errors
Generate AM and PM radiology protocol reports and initiate updates to existing precertification if warranted by clinical procedure change, by following up with physician offices and third-party payors
Responsible for timely transfer of next day unauthorized appointments to CSD and IR WQs for rescheduling and/or cancellation
Support inter-department requests by ensuring timely response to all emails sent to the IVT distribution list. Communicates with surgical, radiology and other departments as needed
Uses online tools, contacts insurance companies, physician offices and patients as needed to verify coverage and authorization within established guidelines. Activities include but are not limited to verifying eligibility, obtaining benefits, ensuring referrals, pre-determination and/or authorization requirements have been completed
Follow up with Physician offices to ensure that diagnosis codes provided meet the medical necessity criteria
Follows up with Penn global team for verifying appointments for patients with international insurance benefits
Ensures that MVA and Worker Compensation related appointments are correctly registered and verified
Processes correspondence from insurance companies, case management, and other departments within specified time limit
Determines and appropriately documents out of pocket responsibility for services as related to insurance contracts or PMPH fee schedules (i.e. Self-Pay Fee Scheduled, Cosmetic Surgery List). Provides patients with an estimate and attempts to collect payment prior to the visit
Follows established department protocols to communicate rescheduling/cancellation of surgeries, procedures and appointments, if authorization is not obtained prior to date of service
Assists IV Team and coordinates the maintenance/repair activities as related to equipment and support of business applications
Maintains working knowledge of Penn Medicine’s Insurance verification tools, including insurance guidelines
Keeps current on CPT/HCPS coding methodologies to accurately identify procedure codes needing authorization. Understands ICD-10 Coding methodologies to accurately identify diagnosis codes to support medical necessity
Must pass and stay current with Penn Chart certification and any other Penn Medicine Princeton Health educational requirements
Works in collaboration with other departmental and hospital associates supporting their efforts through teamwork and acceptance of additional assignments
Is able to accurately and consistently interpret and readily explain various healthcare insurance plans coverage, benefits and patient payment responsibilities
Conforms to all applicable HIPAA, Penn Medicine, Safety and Policy guidelines
Qualification
Required
Must have a minimum of 2+ years hands-on experience in obtaining elective surgery authorizations
Previous experience and proficiency in Orthopedics and General surgery authorizations required
H.S. Diploma/GED (Required)
5-8 YEARS EXPERIENCE IN A HOSPITAL AND/OR PHYSICIAN OFFICE
Associate of Arts or Science
3-5 YEARS EXPERIENCE IN A HOSPITAL AND/OR PHYSICIAN OFFICE
Must pass and stay current with Penn Chart certification and any other Penn Medicine Princeton Health educational requirements
Conforms to all applicable HIPAA, Penn Medicine, Safety and Policy guidelines
Preferred
Local candidate residing in NJ preferred
Education Specialization: Equivalent Experience
Benefits
Comprehensive compensation and benefits program
Prepaid tuition assistance programs
Company
Penn Medicine, University of Pennsylvania Health System
Penn Medicine is a world leader in academic medicine, setting the standard for cutting-edge research, compassionate patient care, and the education of future health care professionals.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$70.9MKey Investors
BIRD FoundationWarren Alpert FoundationNational Cancer Institute
2025-01-22Grant
2023-01-03Grant· $9.7M
2022-08-18Grant· $5.7M
Leadership Team
Kevin Mahoney
Chief Executive Officer of University of Pennsylvania Health System
John Donohue
Vice President, Enterprise Services
Recent News
The Philadelphia Inquirer
2026-01-03
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