Insurance Specialist - Case Management - Casual

Essential Duties and Responsibilities

In this role you will be:

• 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.

QUALIFICATIONS

Required:

• EDUCATION: High school graduate/degree or diploma in a health-related field
• EXPERIENCE:
• 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 years clinical experience hospital or related setting preferred
• Basic computer skills and office equipment experience required