Ins Verify Rep III - Prior Authorization

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 Children's 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 skill 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

 

Primary Location

South Campus

 

Schedule

Full time

 

Shift

Day (United States of America)

 

Department

Financial Clearance Center

 

Employee Status

Regular

 

FTE

1

 

Weekly Hours

40

 

*Expected Starting Pay Range

*Annualized pay may vary based on FTE status

$22.18 - $27.73

 

At Cincinnati Children’s, we come to work with one goal: to make children’s 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 Children’s. 

 Cincinnati Children's is: 

• Recognized by U.S. News & World Report as a top 10  best Children's Hospitals in the nation for more than 15 years 

• Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH) Funding 

• Recognized as one of America’s Best Large Employers  (2025), America’s Best Employers for New Grads (2025) 

• One of the nation's America’s 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) 

 We Embrace Innovation—Together.  We believe in empowering our teams with the tools that help us work smarter and care better. That’s why we support the responsible use of artificial intelligence. By encouraging innovation, we’re creating space for new ideas, better outcomes, and a stronger future—for all of us. 

Comprehensive job description provided upon request.

Cincinnati Children’s 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