Insurance Specialist
About The Position
The on-site Insurance Specialist works under general supervision to support the administrative requirements of Utilization Management. The specialist collaborates with Utilization Management and Concurrent Review Nurses, physicians, staff, and other health care professionals, and interacts with internal and external providers to review and monitor members’ use of health care services in support of high-quality, cost-effective care. The role obtains information from clinical reviews and medical records to provide appropriate communications for authorizing medical services and procedures, and contributes to system-wide quality and performance improvement. This per-diem role assists with authorizations for substance abuse and mental health service lines.
Requirements
- High school diploma.
- One year of experience in a healthcare environment utilizing medical terminology, or completion of a college-level course in medical terminology.
Nice To Haves
- Associate degree in a healthcare-related field.
- One year of case management, utilization review, billing, or coding experience.
Responsibilities
- Initiate and ensure authorizations for all admissions.
- Extract meaningful data from identified patients’ medical records.
- Process electronic communications within identified process standards.
- Participate in quality activities by communicating and coordinating with the care management team to develop tools for optimal consumer outcomes and report findings.
- Forward information about possible concurrent denials to the appropriate Utilization Management or Concurrent Review Nurse within identified process standards.
- Review service denials, gather supporting documentation from chart audits, and follow up according to procedures.
- Provide external notifications of discharges and external post-acute transfers.
- Clarify health plan medical benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
- Participate in discussion and notification processes resulting from clinical utilization reviews with facilities.
Benefits
- Comprehensive benefit packages, including medical, dental, and vision.
- Paid time off.
- 403B.
- Education assistance.
- Onsite fitness center.
- Option for daily pay.
- Tuition reimbursement.
- Scheduling options to balance work, life, school, and recreational calendars.
- Job share opportunities.
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What This Job Offers
Job Type
Part-time
Career Level
Entry Level
Education Level
High school or GED
