Insurance Specialist

About the role

On site position. Looking for up to 3 days per week per diem. The On-site Insurance Specialist under general supervision supports the administrative requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse, physicians, staff and other health care professionals. Interacts with internal and external providers to review and monitor members’ utilization of health care services with the goal of maintaining high-quality cost-effective care. Works collaboratively with staff to obtain information from clinical reviews and medical records in order to provide the appropriate communication for authorization of medical services and procedures. Collaborates on system-wide quality improvement/performance improvement. Per Diem- Insurance Specialist to assist with authorizations for Substance abuse and Mental Health Service lines.

Responsibilities

• Initiates and ensures authorizations for all admissions
• Extracts meaningful data from the medical record of identified patients
• Processes electronic communications within identified process standards
• Actively participates in quality activities by communicating and coordinating with the care management team in the development of tools for optimal consumer outcomes and report findings
• Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified process standards
• Reviews any service denials and gathers necessary supporting documentation from chart audits and follows up according to procedures
• Provides external notifications of discharges and external post-acute transfers
• Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies
• Actively participates in the discussion and notification processes that result from the clinical utilization reviews with the facilities

Requirements

Education: High School Diploma / Associates degree in a healthcare related field preferred.

Experience: One year experience in a healthcare environment utilizing medical terminology or have completed a college level course in medical terminology. One year of case management, utilization review/billing or coding experience preferred.

Benefits

Comprehensive benefit packages available through Trinity Health, including medical, dental, vision, paid time off, 403B, education assistance, onsite fitness center and option for daily pay. Professional development: robust education program, generous tuition reimbursement allowance, collaborative culture encourages individual interests, leaders ensure prepared for evolving landscape, job share opportunities to promote flexibility, satisfaction, and continuous development. Work/Life: scheduling options to balance work/life/school and recreational calendars.

Pay

Pay Range: $23.40 - $33.70. Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Schedule

Employment Type: Part time. Shift: Day Shift. Looking for up to 3 days per week per diem.