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
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Verifies insurance eligibility and benefits for scheduled and unscheduled services to ensure coverage and compliance with payor requirements.
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Calculates and communicates the patient’s estimated financial responsibility for scheduled services.
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Identifies and ensures authorization and referral requirements are met in accordance with payor guidelines.
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Validates and documents all authorizations and referrals according to established policies.
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Reviews and determines the medical necessity of scheduled services based on payor criteria.
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Accurately documents and maintains all required records and communications in compliance with organizational standards.
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Communicates effectively and professionally with patients, physicians, and medical office staff to resolve inquiries and ensure adherence to payor requirements.
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Educates patients on insurance coverage, benefits, and financial responsibility, ensuring clear understanding.
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Processes and indexes incoming orders promptly and ensures compliance with documentation standards.
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Provides timely notification of admission or observation status per payor guidelines for inpatient and observation services.
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Performs other duties as assigned.
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Complies with all policies and standards.
Qualifications
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H.S. Diploma or GED required
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0-1 years of experience in insurance verification, medical billing, or healthcare revenue cycle required
Knowledge, Skills and Abilities
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Strong knowledge of insurance plans, authorization requirements, and medical necessity guidelines.
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Proficiency in Microsoft Office Suite and healthcare information systems (e.g., EMR, eligibility portals).
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Excellent attention to detail and organizational skills.
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Strong communication and interpersonal skills to interact effectively with patients and healthcare professionals.
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Ability to work in a fast-paced environment and manage multiple priorities effectively.
Equal Employment Opportunity
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.
