Insurance Specialist-6027

Kingman Healthcare • Kingman, AZ

2d

About The Position

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

Requirements

• High School Diploma or GED Equivalent
• Experience with office machines (i.e., copier, fax, telephone), computer terminal/personal computer, software and payor portals (i.e., word processing, spreadsheets, etc.)
• Strong oral and written communication skills, must have excellent attention to detail as well as superb interpersonal skills in interacting with payers and healthcare team members
• Able to handle multiple priorities simultaneously
• Ability to sit for 3-5 hours per day
• Ability to stand for 3-5 hours per day
• Ability to walk for 3-5 hours per day

Nice To Haves

• Associate degree or higher in business or healthcare related field
• 2 years of experience in a healthcare setting performing related duties such as insurance claims, utilization review, doctor’s office, DME, etc.
• Expertise and knowledge of third-party payer requirements and regulations including Medicare/Medicaid, managed care payers, commercial insurance companies, worker’s comp, etc.
• Knowledge and expertise in developing and using data management tools such as Excel, Access, etc

Responsibilities

• Serves as Primary Contact for all payer requests for clinical information and utilization review decisions, in an efficient and professional manner.
• Serves as primary communicator to Case Managers, Physicians and Physician Advisors when clinical information if requested/received from the payor.
• Obtains and tracks appropriate information from Case Managers/Utilization Review Nurses and transmits to payers via fax, phone, or email, within the timeframe determined by the payer.
• Tracks cases to ensure authorization is received from the payer within 24 to 48 hours.
• Communicates authorization information to Case Manager/Utilization Review Nurse and updates information into the EMR and ARM module.
• Arranges and tracks Peer-to-Peers for physicians and works medical necessity denials in a timely manner.
• Demonstrates EMR and ARM module notes are concise and accurately reflects the activity and outcome.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED