Insurance Specialist – Authorizations

Beneficios

: 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

Requisitos

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.

Responsabilidades

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 admi.