Job detail

Insurance Specialist - Case Management - Casual

Indiana Regional Medical Center

#Case Management #HIPAA #Electronic Health Record #Medicare #Medicaid #Medical Documentation #Insurance Authorizations #Insurance Verification

Quick overview

The specialist will be responsible for verifying patient insurance eligibility, benefits, and authorization requirements before or during services, and obtaining necessary initial and continued insurance authorizations for inpatient stays. This role also involves communicating coverage details and financial obligations to patients and staff, and ensuring medical documentation aligns with payer guidelines.

Requirements summary

Candidates must have a high school diploma or equivalent, preferably in a health-related field. Required experience includes basic computer skills, while preferred experience involves daily use of insurance portals for verification, denials/appeals coordination, and familiarity with specific software like Davinician or Optum, along with a minimum of one year of clinical experience in a hospital setting.

high schoolMedicare KnowledgeMedicaid KnowledgeUtilization ReviewAudit AssistanceAuthorization ManagementElectronic Health Record DocumentationBilling SystemsInsurance Eligibility VerificationClinical CoordinationMedical Documentation ReviewPayer Guidelines ComplianceReimbursement RegulationsBenefit InvestigationCoverage Issue ResolutionPayer Policy UpdatesCommercial Plan Knowledge

Job description

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