Insurance Verification Specialist

Heart Care Centers of Illinois, a multi-site network of cardiovascular providers, currently has an opening for an Insurance Verification Specialist responsible for providing guidance, instruction, and assistance to the managed care team and front desk staff. The ideal candidate will possess a strong understanding of managed care, medical office procedures, and insurance verification processes. In this role, you will be responsible for verifying patient insurance coverage, ensuring compliance with HIPAA regulations, and facilitating smooth billing operations. Your expertise in medical terminology, coding systems, and insurance protocols will be vital in supporting accurate patient account management and optimizing revenue cycle processes.

Major Duties and Responsibilities:

• Process and prioritize insurance verifications, referrals, and prior authorization requests. Refers authorization requests that require clinical judgment to Prior Authorization Supervisor.
• Verifies member/patient eligibility, entering information in IDX system. Ensures insurance carrier documentation requirements are met and referral support documentation is filed in patient records.
• Trains new and existing front desk staff on managed care procedures and protocols.
• Identifies and informs callers of network providers, services, and available member benefits. Informs providers of patient service decisions. Support prior authorizations and referral clinicians.
• Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
• Maintains and updates general understanding of application sections of evidence of coverage, handbooks, etc. Assists other Managed Care Specialists with questions and concerns.

Requirements

• Minimum of 1 year experience with Health Plan Utilization/Insurance Claims, knowledge of third party payor regulations, compliance policies, medical terminology and coding
• Strong knowledge of managed care plans, HIPAA regulations, and healthcare compliance standards.
• Excellent communication skills for interacting effectively with patients, providers, and insurance representatives.

Heart Care Centers of Illinois offers a competitive salary with great benefits and a weekday only/no evenings schedule. Apply today!

Pay: From $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Retirement plan
• Vision insurance
• Wellness program

Work Location: In person