Insurance Specialist

Cleveland Clinic

3d•Remote

About The Position

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world. As an Insurance Specialist, you will perform insurance prescreening and verification of benefits for multiple business lines within Connected Care, including Home Infusion, Hospice, Nursing, and Respiratory Therapy. In this role, you will determine serviceability and provide appropriate recommendations based on patients’ insurance coverage. You will communicate with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients, and families to ensure a clear understanding of approved benefit levels. A caregiver in this position works remotely from 8:30 a.m. – 5:00 p.m. To be considered for this role, caregivers must reside in Ohio and within two hours of an Ohio Cleveland Clinic location.

Requirements

High School Diploma / GED or equivalent
Two years of related experience in medical business office or medical insurance environment
Excellent organizational, verbal and written communication skills
Ability to identify and resolve problems
Ability to work under pressure and meet deadlines
Customer service experience, excellent customer service focus and orientation
Proficient computer knowledge and skills
Medical terminology and/or successful completion of a medical terminology class or commensurate experience

Nice To Haves

Related college course work in business, finance or accounting
Insurance and Medicare verification experience
Commercial insurance knowledge
Medicare and Medicare product experience
Prior authorization experience
Understanding of payer requirements and guidelines
Experience with EMR systems such as Epic

Responsibilities

Perform insurance prescreening and verification of benefits for multiple business lines within Connected Care (such as but not limited to: Home Infusion, Hospice, Nursing and Respiratory).
Determine serviceability and make recommendations based on patient’s insurance coverage.
Identify the need for and obtain authorizations for service, calculate billable units for authorizations, understand the drug formularies, different therapies and the associated diagnoses with each and examination of referrals for adherence to the required/qualifying insurance regulations.
Communicate directly with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients and families to ensure understanding of approved benefit levels.
Maintain customer relationships and ensures business objectives are met.
Perform insurance verification for respiratory services and equipment.
Verify coverage for CPAP, BiPAP, oxygen, nebulizers, suction equipment, and other respiratory-related durable medical equipment (DME).
Process prior authorizations and ensure required documentation is obtained.
Understand and apply payer guidelines to support accurate coverage determinations.
Provide support for infusion authorization work as needed.
Other duties as assigned.