Insurance Verification Specialist I - REMOTE
我们的好处：· 工资助理 · 薪酬假期 · 员工激励计划 (ICP) · 集团医疗，牙科和视觉 · 教育援助 · 401 ((k) 计划 · 病时 · 生活保险/意外死亡和解体 ·长期和短期残疾 · 医疗和儿童护理灵活支出账户 · 员事协助计划 (EAP) 工作总结 保险专家 I 负责验证保险资格和福利，确保授权要求得到满足，并完成预注册程序。保险专家 I 通过教育患者关于保险福利和财务责任，同时保持高标准的准确性和专业化支持金融清算过程。基本功能：·验证计划和未规划服务的保险资格和福利，以确保覆盖和符合付款人员要求。·计算并传达病人对计划服务的估计财务责任。· 根据付款者标准，确定并确保授权和转让要求符合纳税人指南。· 根据已建立的政策验证和记录所有授权和推。· 审查并确定定期服务的医疗必要性。· 正确地记录和保持所有需要的记录和通信，遵守组织标准。· 与患者，医生和医务办公室人员有效而专业沟通以解决查询并确保遵守付费或要求。· 教育病人保险覆盖，福利和财务责任，确保了明确的理解。· 快速处理和索引接入的订单，并确保遵守文件标准。· 根据住院或观察服务员的薪酬或指南及时通知受访者或观察状态。· 执行其他任务按分配情况。· 符合所有政策和标准。· 这是一个远程职位。
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Our Benefits:
- PTO
- Paid holidays
- Employee Incentive Program (ICP)
- Group Medical, Dental, & Vision
- Educational Assistance
- 401(k) Plan
- Sick Time
- Life Insurance/Accidental Death and Dismemberment
- Long-Term and Short Term Disability
- Medical and Child Care Flexible Spending Accounts
- Employee Assistance Program (EAP)
Job Summary
The Insurance Specialist I is responsible for verifying insurance eligibility and benefits, ensuring authorization requirements are met, and completing pre-registration processes for scheduled outpatient and inpatient services. This role ensures compliance with payor guidelines and provides timely and accurate communication with patients, providers, and medical office staff. The Insurance Specialist I supports the financial clearance process by educating patients on insurance benefits and financial responsibilities while maintaining high standards of accuracy and professionalism.
Essential Functions:
- Verifies insurance eligibility and benefits for scheduled and unscheduled services to ensure coverage and compliance with payor requirements.
- Calculates and communicates the patient’s estimated financial responsibility for scheduled services.
- Identifies and ensures authorization and referral requirements are met in accordance with payor guidelines.
- Validates and documents all authorizations and referrals according to established policies.
- Reviews and determines the medical necessity of scheduled services based on payor criteria.
- Accurately documents and maintains all required records and communications in compliance with organizational standards.
- Communicates effectively and professionally with patients, physicians, and medical office staff to resolve inquiries and ensure adherence to payor requirements.
- Educates patients on insurance coverage, benefits, and financial responsibility, ensuring clear understanding.
- Processes and indexes incoming orders promptly and ensures compliance with documentation standards.
- Provides timely notification of admission or observation status per payor guidelines for inpatient and observation services.
- Performs other duties as assigned.
- Complies with all policies and standards.
- This is a remote position.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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Required:
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Education: H.S. Diploma or GED
- Experience: 0-1 years of experience in insurance verification, medical billing, or healthcare revenue cycle
Knowledge, Skills and Abilities:
- Strong knowledge of insurance plans, authorization requirements, and medical necessity guidelines.
- Proficiency in Microsoft Office Suite and healthcare information systems (e.g., EMR, eligibility portals).
- Excellent attention to detail and organizational skills.
- Strong communication and interpersonal skills to interact effectively with patients and healthcare professionals.
- Ability to work in a fast-paced environment and manage multiple priorities effectively.
We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
The Sarasota SSC operates in support of our hospitals and patients and our commitment is to provide them with exemplary revenue cycle services defined by outstanding customer service and superior revenue cycle performance. SSC Sarasota supports facilities located primarily in Florida, Georgia, Indiana, and Pennsylvania.
Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.
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Originally posted on Himalayas