Insurance Specialist - Case Management - Full Time
About The Position
This is a full-time role for an Insurance Specialist in Case Management. The primary responsibilities involve verifying patient insurance eligibility and benefits, obtaining and managing insurance authorizations for inpatient services, and communicating coverage details to patients and hospital staff. The role requires reviewing medical documentation for compliance, coordinating with clinical teams, and maintaining accurate records in electronic health and billing systems. The specialist will also act as a liaison between the hospital, insurance companies, and patients, staying updated on payer policies and assisting with audits and compliance reviews.
Requirements
- High school graduate/degree or diploma in a health-related field
- Experience with daily insurance portals that require verification process and barriers preferred
- Denials/appeals coordination as well as experience with software including, but not limited to, Davinician, Optum, HER, Challenger, Xsolis
- Minimum 1 year's clinical experience hospital or related setting preferred
- Basic computer skills and office equipment experience required
Nice To Haves
- Experience with daily insurance portals that require verification process and barriers
- Minimum 1 year's clinical experience hospital or related setting
Responsibilities
- Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to or during services.
- Obtain and manage initial and continued insurance authorizations for inpatient services, including admissions, procedures, and extended stays.
- Conduct insurance benefit investigations and communicate coverage details, patient responsibility, and financial obligations to patients, families, and hospital staff as appropriate.
- Review medical documentation to ensure medical necessity and compliance with payer guidelines.
- Coordinate with clinical staff, case management, utilization review, and physicians to obtain required clinical information for authorizations and appeals.
- Maintain accurate and timely documentation of insurance verification, authorizations, communications, and payer determinations in the electronic health record and billing systems.
- Serve as a liaison between the hospital, insurance companies, and patients to resolve coverage issues and payment discrepancies.
- Stay current on payer policies, reimbursement regulations, and changes in insurance requirements, including Medicare, Medicaid, and commercial plans.
- Assist with audits and compliance reviews related to insurance authorization and reimbursement.
- Ensure compliance with hospital policies, federal and state regulations, and HIPAA privacy standards.
- Perform other related duties as assigned to support revenue cycle operations and patient access services.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
