insurance specialist

HCA Healthcare

<div>**After 90 days, Hybrid/Remote work may be available &ndash; Interested candidates must live in the local Kansas City metro area.** Hours: 7:30AM-4:00PM**
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As an Insurance Specialist with HCA Healthcare you can be a part of an organization that is devoted to giving back!
<h5 class="jobSectionHeader">Job Summary and Qualifications</h5>
As the Collections Representative, you will contribute to the company&rsquo;s mission, vision, and values by completing follow-up and collections for patient services. Under the supervision of the Business Office Manager/Business Office Supervisor, you will obtain payment from third party payers and self-pay accounts to enhance cash flow and gather reimbursement based on established contracts.
What you will do in this role:<ul><li>
You will perform follow up activities on accounts to ensure prompt payment</li><li>
You will identify coding or billing errors from EOBs and work to correct them</li><li>
You will monitor insurance claims and contact insurance companies to resolve claims</li><li>
You will update the patient account record to identify actions taken</li><li>
You will assign bad debt to the collection agency</li><li>
You will act as a liaison accounts and administer contracts in collection of third partyaccounts (Medicare and Medicaid)</li><li>
You will complete account reconciliation of accounts turned over to outside agencies</li><li>
You will negotiate payment plans on self-pay accounts</li><li>
You are responsible for maintaining accounts receivable and creating a reduction in bad debt</li></ul>
Qualifications you will need:<ul><li>
Minimum (1) year of experience in a medical office setting highly preferred. (i.e. ambulatory surgery center, hospital, doctors office) preferred</li><li>
Knowledge of managed care payers and medical terminology is preferred</li></ul>
<h5 class="jobSectionHeader">Benefits</h5>
HCA Healthcare, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
At the Surgery Ventures Central Business Office in MidAmerica, we support financial and patient care operations of 10 ambulatory surgery centers across the Kansas City Metro. Staff are assigned to work with one or more surgery centers via remote, in office and hybrid working environments.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. 
&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Insurance Specialist opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Insurance Specialist

DC Department of Human Resources

<div>
 
 (This position may be filled at any of the following grade levels, CS-09, CS-11, or CS-12, and has promotion potential within the career ladder to the next grade level.)
 
 
 
 
 SALARY RANGE PER GRADE LEVEL
 
 
 
 Grade CS-9 - $62,158 - $80,032
 
 
 Grade CS-11 - $74,893 - $96,547
 
 
 Grade CS-12 - $92,656 - $118,558
 
 
 If you like to stay busy and immersed in cultural activities, then Washington, DC is the place to be! Museums, restaurants, great climate, green space and job opportunities are among the many positives of living in the Nation&rsquo;s Capital. Not to mention the residents of the District of Columbia are highly educated and the region has some of the best schools in the country. Each day the District of Columbia continues to be ranked in the top 10 of thriving city indicators where you can live, work and play.
 
 
 
 INTRODUCTION
 
 
 
 This position is located in the Disability Determination Division, Rehabilitation Services Administration, Department on Disability Services. The Disability Determination Division determines the absence or presence of a disability and adjudicates claims and their appeals for disability benefits under the Social Security Act. All program costs are fully reimbursed from the Social Security Administration.
 
 
 
 MAJOR DUTIES
 
 
 
 The incumbent will review and analyze Initial claims for evidence of illness, injury, disease, and/or other medical conditions and vocational factors, which prevent an individual from working or gaining employment. Conducts interviews to obtain, clarify and verify information about Initial eligibility for benefits. Adjudicates claims for benefits using conventional procedures that easily apply to most situations. Determines if applicants for or recipients of disability insurance are engaging in substantial gainful employment. Prepares an analysis explaining the facts of the case and the basis for the decision and provides written notice to the claimant and the Social Security Administration.
 
 
 <ul>
 <li>
 Maintains a caseload of initial claims for Social Security Disability and Supplemental Security Income, developing appropriate information and evidence. Analyzes facts, evidence, and allegations to determine accuracy and applicability.
 </li>
 <li>
 Completes case reviews and writes a comprehensive analysis on initial disability cases, at different stages of development, in order to assure compliance with the Social Security laws and regulations and legal statutes utilizing the appropriate internal office procedures.
 </li>
 <li>
 Interviews or corresponds with claimants, family members, legal representatives, employers, community resources and others as needed, to obtain additional information or collateral evidence concerning an individual's functional abilities.
 </li>
 <li>
 Conducts interviews with claimants, family, case workers, medical providers, and others to obtain, clarify, and verify information for Initial claims.
 </li>
 <li>
 Interprets the various medical reports and evaluates the age and authenticity of evidence submitted as proof of eligibility in compliance with Social Security rules and regulations (POMs).
 </li>
 <li>
 Determines the need for additional medical tests, evaluations, or consultative examinations in the fields of medicine, psychology, psychiatry, or other specialties.
 </li>
 <li>
 Prepares a written residual functional capacity assessment based on the severity of the medical, psychological, and all applicable potential other conditions and how the nature of the impairment impacts the function and ability to work at the level of substantial gainful activity.
 </li>
 <li>
 Consults with internal and external professionals or contract providers, including physicians, psychologists, counselors, speech and language pathologists, social workers, and vocational experts to address issues and provide specialized guidance.
 </li>
 <li>
 Reviews vocational factors in correlation with the established medical assessments and provides an explanation of ability to return to past work, transfer to other work, or pardoned from any available work in the national economy due to medical factors.
 </li>
 <li>
 Prepares a detailed written analysis explaining the facts of the case and the basis for the decision and provides written notice to the claimant and the Social Security Administration.
 </li>
 <li>
 Protects and safeguards confidential and sensitive personal, medical, and vocational information in accordance with federal and state mandates.
 </li>
 <li>
 Performs other duties as assigned.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 Applicant must have one (1) year of Specialized Experience at the next lower grade level. Three years of related work experience that equipped the applicant with the particular knowledge, skills, and abilities to successfully perform the duties of the position and is related to adjudicating and authorizing entitlement or disallowance actions at all levels of difficulty and complexity under programs administered by SSA.
 
 
 You must meet all qualifications and eligibility requirements by the closing date of this announcement.
 
 
 
 Applicants must have met the qualifications requirements for this position by the closing date to be eligible for this position.
 
 
 
 
 Education, Licenses, Certifications, And Other Requirements
 
 
 
 2 years of progressively higher-level graduate education leading to a master&rsquo;s degree or master&rsquo;s equivalent graduate degree. An equivalent combination of education and experience will be considered.
 
 
 
 Work Experience/Knowledge
 
 
 
 Knowledge of policies, procedures, and provisions of the Social Security Act concerning eligibility for disability benefits, Social Security rulings, and pertinent court rulings.
 
 
 Knowledge of other Federal and State benefits, tax, citizenship, veterans, and welfare programs and as appropriate, international legal agreements, other public, private, and nonprofit retirement programs and other programs that interrelate with social insurance programs.
 
 
 Knowledge of Federal and State laws regarding confidentiality of personal information and procedures for obtaining and disclosing information and validity of marriage, divorce, descent, and distribution of property as they affect eligibility for social insurance benefits.
 
 
 Knowledge of the agency's integrated automated case processing systems and skill in using the systems' input and output, methodology, forms, and data.
 
 
 Skill in obtaining and evaluating information concerning an individual's functional abilities, employment, education, and other factors.
 
 
 Ability to research precedent decisions and other reference materials
 
 
 
 Collective Bargaining Unit
 
 
 
 This position is in the collective bargaining unit represented by the local union AFSCME 2401.
 
 
 
 Additional Information
 
 
 
 Once applications are submitted, applicants will not be able to change their responses to the online questions.
 
 
 The position for which the individual is applying has been identified and designated as requiring enhanced suitability screening.
 
 
 If tentatively selected for the position, a criminal background check, traffic record check, consumer credit check, and mandatory drug and alcohol test will be conducted (
 
 as appropriate
 
 ); and
 
 
 The appointee to the position may be offered employment contingent upon receipt of a satisfactory enhanced suitability screening.
 
 
 
 Work Schedule
 
 
 
 This position requires 4 days a week in the office.
 
 
 
 How You Will Be Evaluated
 
 
 
 You will be evaluated for this job based on how well you meet the qualifications above. Your application includes your resume, responses to the online questions, and required supporting documents. Please be sure that your resume includes detailed information to support your qualifications for this position; failure to provide sufficient evidence in your resume will result in a "not qualified" determination.
 
 
 
 EEO Statement
 
 
 
 The District of Columbia Government is an Equal Opportunity Employer. All qualified candidates will receive consideration without regard to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, physical handicap, or political affiliation.
</div>

Social Insurance Specialist

GetixHealth

<div>
 Job Details
 
 
 
 Description
 
 
 
 
 Join our team as an Insurance Specialist!
 
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Provides service via all available omni channels to serve as the liaison between the business, clients, patients, and other parties, such as insurance companies.
 </li>
 <li>
 Offers education on the healthcare revenue cycle and troubleshoots accounts through resolution by reviewing large balance accounts and other departmental insurance discovery processes.
 </li>
 <li>
 Engages in and enjoys active listening with callers, confirming or clarifying information and diffusing conflict.
 </li>
 <li>
 Makes appropriate changes or documentation in client healthcare systems and internal technology platforms.
 </li>
 <li>
 Submits claims to insurance providers on behalf of our clients for their patients, following through to resolution.
 </li>
 <li>
 Contributes to the development of workflows for incoming clients, developing procedures and communicating expectations to the contact center.
 </li>
 <li>
 Proactively shares information about healthcare revenue cycle services to support the growth of the business&rsquo;s client and/or account base.
 </li>
 <li>
 Follows department processes and procedures in compliance with industry laws and regulations.
 </li>
 <li>
 Manages inventory to ensure metrics are being met to patient&rsquo;s accounts are not being sent to collections prior to resolution.
 </li>
 <li>
 Reviews and escalates complex accounts requiring additional review.
 </li>
 <li>
 Meets the key performance indicators and expectations established for the position.
 </li>
 <li>
 Performs all duties above with the highest integrity and confidentiality.
 </li>
 <li>
 Completes assigned training and learning plans, including those that fulfill industry compliance requirements.
 </li>
 <li>
 All other duties as assigned.
 
 
 </li>
 </ul>
 
 Education &amp; Experience
 
 
 
 
 Required Education: High School Diploma / GED
 
 
 Preferred Education: Two Years of College or Associate's Degree
 
 
 
 
 Experience
 
 
 
 <ul>
 <li>
 1+ year(s) of experience in a customer service capacity required, preferably in a contact center environment
 </li>
 <li>
 1+ year(s) of experience multi-tasking in a fast- paced environment required
 </li>
 <li>
 1+ year(s) of experience with medical insurance, coding, or billing in a professional environment
 
 
 </li>
 </ul>
 
 Benefits &amp; Incentives
 
 
 
 <ul>
 <li>
 Comprehensive Health Coverage: Enjoy medical, dental, and vision plans available starting after 60 days of full-time employment.
 </li>
 <li>
 Life &amp; Disability Insurance: Benefit from basic life/AD&amp;D, short-term, and long-term disability coverage, with optional voluntary life/AD&amp;D plans.
 </li>
 <li>
 401(k) Plan: Eligible to participate in the company&rsquo;s 401(k) plan after three (3) months of continuous service.
 </li>
 <li>
 Paid Time Off (PTO): Start accruing PTO from your very first day of employment.
 </li>
 <li>
 Flexible Benefits: Customize your benefits package to fit your personal and family needs.
 
 
 </li>
 </ul>
 
 
 GetixHealth/Americollect is an equal opportunity employer and participates in E-Verify.
 
 
</div>

Remote Insurance Specialist (Collections)

AR Insurance Specialist - Mountain Standard Time

DoorDash

<div>
 
 About The Team
 
 
 
 The Risk &amp; Insurance team at DoorDash is responsible for all things corporate insurance at the company. We are a rapidly growing and exciting function that helps DoorDash manage risk and safety with a close lens on the company's bottom line. The team is divided into three separate subgroups: Actuarial, Claims Operations, and Risk Management &amp; Mitigation. We are looking for forward thinkers excited to help build out this newly-formed team and match our ambitious cross-functional partners at DoorDash.
 
 
 
 About The Role
 
 
 
 We are seeking an experienced claims specialist who will be a member of DoorDash's Corporate Risk &amp; Insurance function with the Finance &amp; Strategy team. You will work with our insurance carrier partners and third-party claims administrators with a focus on auto insurance claims. You will help form a comprehensive strategy around claims handling at DoorDash. Prior insurance experience and an understanding of injury and property damage claims are required.
 
 
 You will report to the Insurance Claims Manager and work a hybrid schedule at our Tempe, AZ office.
 
 
 During the onboarding period, which will last 4-6 weeks, you will work Monday to Friday and be required to come into the Tempe, AZ office 4-5 days a week.
 
 
 Once you have completed the onboarding process, your regular work schedule will be Monday through Friday, with the possibility of working on a Saturday within our operating hours of 8 a.m. to 7 p.m. Additionally, you will be required to come into the Tempe, AZ office every Wednesday, with the potential of working in the office 2-3 days a week in the future, based on your performance.
 
 
 
 You're Excited About This Opportunity Because You Will&hellip;
 
 
 
 <ul>
 <li>
 Review loss reports and supporting materials for workers' compensation and occupational accidents.
 </li>
 <li>
 Addresses escalating incidents. This involves identifying potential issues, assessing the severity of the risk, and taking appropriate steps to mitigate the risk and prevent further escalation. It also means maintaining detailed records of the incident and following up with stakeholders to ensure that the issue has been resolved.
 </li>
 <li>
 Contribute to process improvements and provide constructive input regularly.
 </li>
 <li>
 Partner with leadership to manage ongoing projects. This involves working closely with management to set project goals, establish timelines, and allocate resources.
 </li>
 <li>
 Enjoy a hybrid work schedule.
 </li>
 <li>
 Enter accurate data in CRMs, G-Suite, and related tools.
 </li>
 <li>
 Manage multiple operating systems simultaneously.
 </li>
 <li>
 Maintain a high level of confidentiality and ensure that sensitive information is not disclosed to unauthorized parties.
 
 
 </li>
 </ul>
 
 We're Excited About You Because&hellip;
 
 
 
 <ul>
 <li>
 1+ years of experience handling bodily injury claims
 </li>
 <li>
 2+ years of experience managing personal lines, commercial lines, or general liability claims.
 </li>
 <li>
 Experience working with or for a gig or sharing economy company
 </li>
 <li>
 Experience handling high-priority escalations and working promptly to provide resolutions
 </li>
 <li>
 Enthusiasm for Insurance
 </li>
 <li>
 Must be comfortable regularly exercising discretion and independent judgment in performing job duties, including evaluating options, making informed decisions, and determining appropriate courses of action within the scope of assigned responsibilities.
 
 
 </li>
 </ul>
 Notice to Applicants for Jobs Located in NYC or Remote Jobs Associated With Office in NYC Only
 
 
 We use Covey as part of our hiring and/or promotional process for jobs in NYC and certain features may qualify it as an AEDT in NYC. As part of the hiring and/or promotion process, we provide Covey with job requirements and candidate submitted applications. We began using Covey Scout for Inbound from August 21, 2023, through December 21, 2023, and resumed using Covey Scout for Inbound again on June 29, 2024.
 
 
 The Covey tool has been reviewed by an independent auditor. Results of the audit may be viewed here: Covey
 
 
 
 About DoorDash
 
 
 
 At DoorDash, our mission to empower local economies shapes how our team members move quickly, learn, and reiterate in order to make impactful decisions that display empathy for our range of users&mdash;from Dashers to merchant partners to consumers. We are a technology and logistics company that started by enabling door-to-door delivery, and we are looking for team members who can help us go from a company that is known as the place you order food to a company that people turn to for any and all goods.
 
 
 DoorDash is growing rapidly and changing constantly, which gives our team members the opportunity to share their unique perspectives, solve new challenges, and own their careers. We're committed to supporting employees&rsquo; happiness, healthiness, and overall well-being by providing comprehensive benefits and perks including premium healthcare, wellness expense reimbursement, paid parental leave and more.
 
 
 Our Commitment to Diversity and Inclusion
 
 
 We&rsquo;re committed to growing and empowering a more inclusive community within our company, industry, and cities. That&rsquo;s why we hire and cultivate diverse teams of people from all backgrounds, experiences, and perspectives. We believe that true innovation happens when everyone has room at the table and the tools, resources, and opportunity to excel.
 
 
 Statement of Non-Discrimination: In keeping with our beliefs and goals, no employee or applicant will face discrimination or harassment based on: race, color, ancestry, national origin, religion, age, gender, marital/domestic partner status, sexual orientation, gender identity or expression, disability status, or veteran status. Above and beyond discrimination and harassment based on &ldquo;protected categories,&rdquo; we also strive to prevent other subtler forms of inappropriate behavior (i.e., stereotyping) from ever gaining a foothold in our office. Whether blatant or hidden, barriers to success have no place at DoorDash. We value a diverse workforce &ndash; people who identify as women, non-binary or gender non-conforming, LGBTQIA+, American Indian or Native Alaskan, Black or African American, Hispanic or Latinx, Native Hawaiian or Other Pacific Islander, differently-abled, caretakers and parents, and veterans are strongly encouraged to apply. Thank you to the Level Playing Field Institute for this statement of non-discrimination.
 
 
 Pursuant to the San Francisco Fair Chance Ordinance, Los Angeles Fair Chance Initiative for Hiring Ordinance, and any other state or local hiring regulations, we will consider for employment any qualified applicant, including those with arrest and conviction records, in a manner consistent with the applicable regulation.
 
 
 
 If you need any accommodations, please inform your recruiting contact upon initial connection.
 
</div>

Insurance Claims Specialist

Invisible Agency

<div><h3 class="jobSectionHeader">Project Overview</h3>

We are sourcing independent Finance and Insurance Specialists to provide their expertise for an AI benchmark evaluation project. As AI models increasingly generate professional-grade financial and insurance deliverables, their accuracy relies entirely on robust, expert-crafted training data. The objective of this project is to autonomously produce high-quality evaluation tasks, strong prompts, and clear, well-structured rubrics that generate clean, reliable data for model training.
<h3 class="jobSectionHeader">
Project Deliverables &amp; Scope</h3>

Operate autonomously to design complex evaluation frameworks and provide structured training data. Expected deliverables include:
<ul>
<li>Task &amp; Prompt Creation: Generating realistic, high-quality prompts that compel the AI model to produce complex, professional-grade deliverables specific to the finance and insurance sectors.</li>
<li>Rubric Development: Writing clear, well-structured evaluation rubrics with criteria that are highly specific, non-ambiguous, and easy to score.</li>
<li>Benchmark Evaluation Data Generation: Producing clean, reliable training data that directly aids in the evaluation and refinement of AI models handling industry-specific tasks.</li>
<li>Quality Assurance &amp; Fact-Checking: Ensuring all generated tasks and scoring criteria reflect strict, real-world industry standards and regulatory realities.</li>
</ul><h3 class="jobSectionHeader">Required Expertise</h3>

To successfully fulfill the deliverables of this project, Contractors must possess deep industry knowledge to craft realistic professional scenarios.

Core skillset includes:
<ul>
<li>Demonstrable professional expertise within the Finance and Insurance sectors, with a deep understanding of industry standards, terminology, and high-level deliverables.</li>
<li>Strong writing and prompt generation skills, with the ability to design highly realistic, complex task scenarios for AI evaluation.</li>
<li>Proficiency in rubric generation, specifically the ability to create objective, non-ambiguous scoring criteria that leave no room for subjective interpretation.</li>
<li>A meticulous, detail-oriented approach to generating clean, reliable data for system benchmarking.</li>
</ul>
We offer a pay range of $10-$30 per hour, with the exact rate determined after evaluating your experience, expertise, and geographic location. Final offer amounts may vary from the pay range listed above. As a contractor you'll supply a secure computer and high‑speed internet; company‑sponsored benefits such as health insurance and PTO do not apply.

Engagement Type: Freelance / Independent Contractor

Workplace Type: Remote</div>

Finance and Insurance Specialist - Freelance AI Trainer Project

Beacon Health System

<div><div><div><div><div><div>Beacon Health System is hiring a full-time day Patient Access Insurance Specialist, in our Verification of Benefits Department at Beacon Health System in South Bend, IN. 
 
Be a Beacon. Make a Difference.
At Beacon Health System, you&rsquo;re not just part of a team, you&rsquo;re part of something bigger. Every patient interaction is a chance to lead with compassion, build trust, and create lasting impact. Here, your expertise supports healing, and your heart connects us to the communities we serve.
<ul><li>Medical, Dental, &amp; Vision Insurance through Cigna</li>
</ul><ul><li>Life Insurance</li>
</ul><ul><li>403(b) Matching Retirement Fund</li>
</ul><ul><li>Competitive Paid Time Off (PTO)</li>
</ul><ul><li>Shift Differentials</li>
</ul><ul><li>Employee Assistance Program (EAP)</li>
</ul><ul><li>Tuition and Certification Reimbursement</li>
</ul><ul><li>Clinical Ladder Program</li>
</ul><ul><li>Local and National Discounts</li>
</ul><ul><li>Beacon Academy Educational Courses</li>
</ul><ul><li>Gym Membership Discount</li>
</ul>
About Beacon Health System
Headquartered in South Bend, Indiana, as a not-for-profit, community-governed health system, Beacon Health System provides care to more than 4,000 patients each day in northern Indiana and southern Michigan.
What You&rsquo;ll Do
As a Patient Access Insurance Specialist, you will report to the Patient Access Director or the Insurance Specialist Supervisor. Follows established Beacon policies and procedures to verify insurance coverage to ensure necessary procedures and hospitalizations are covered by an individual's provider. The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures. They will work closely with medical staff, clinical staff, referring clinics, Beacon Outpatient Scheduling Surgery Scheduling, Social Services, and Utilization Review departments. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring authorization, pre-certification, and prior approval for admissions to Beacon or Epworth Center by using web-based tools, other electronic means where possible, or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. They will answer high volume of incoming phone calls as well as making high volume of outbound phone calls, with constant communication to the Utilization Review, Social Services, Beacon Outpatient Scheduling and Surgery Scheduling departments. Performs other clerical duties as necessary.
Patient Access Insurance Specialist Job Responsibilities:
<ul><li>Verify and update patient demographic and financial information to ensure accuracy in the registration system.</li>
<li>Obtain and validate insurance coverage using online eligibility systems, payer portals, and telephone verification.</li>
<li>Utilize Cerner systems and reports (e.g., PHS, SurgiNet, Medical Necessity Checker) to review scheduled patients, procedures, and medical necessity requirements.</li>
<li>Audit and complete required documentation, including MSP questionnaires and insurance verification records.</li>
<li>Coordinate verification of benefits (VOB) by confirming co-pays, deductibles, coinsurance, out-of-pocket limits, and rehabilitation benefits with insurance providers.</li>
<li>Secure and document pre-authorizations and pre-certifications for ancillary, surgical, outpatient, and inpatient procedures.</li>
<li>Collaborate with physician offices, scheduling teams, and referring facilities to ensure required authorizations are obtained and procedures are properly scheduled.</li>
<li>Validate CPT and ICD-10 codes and confirm compliance with Medicare Inpatient Only Procedure (MIPO) requirements when applicable.</li>
<li>Identify out-of-network insurance plans and follow established policies and procedures.</li>
<li>Refer patients to Financial Counselors or Eligibility Specialists when financial clearance or payment arrangements are required.</li>
<li>Maintain accurate worklists, documentation, and records to support timely claim submission and reimbursement.</li>
<li>Calculate and communicate estimated patient financial responsibility, including co-payments and coinsurance.</li>
<li>Prepare reports, patient statistics, and documentation to support departmental operations and leadership requests.</li>
<li>Provide professional customer service by answering calls, communicating with patients and internal departments, and maintaining positive patient relations.</li>
<li>Collaborate with departments such as Utilization Review, Surgery Scheduling, Social Services, and Outpatient Scheduling to ensure accurate and timely patient processing.</li>
<li>Support departmental quality goals by maintaining productivity, accuracy, and compliance with Beacon policies and procedures.</li>
<li>Maintain professionalism while representing Beacon Health System and perform other duties as assigned.</li>
</ul>
What You Bring
As a Patient Access Insurance Specialist, it requires strong office and computer skills, including keyboarding (minimum 40 wpm), data entry, and proficiency with systems such as Cerner, Pathways Healthcare Scheduling, Experian, and MCA Compliance Checker. Demonstrates knowledge of medical terminology, insurance coverage, managed care networks, ICD-10 and CPT codes, and time-of-service collections, including the ability to clearly communicate financial responsibilities to patients. You will possess strong telephone, verbal communication, and listening skills to effectively interact with patients, insurance companies, physicians, and internal departments. You will maintains professionalism and sensitivity when working with diverse populations, follows strict confidentiality policies, exercises sound judgment in stressful situations, and applies basic math skills to calculate patient financial responsibilities such as deductibles, coinsurance, and out-of-pocket costs.
Required Qualifications
<ul><li>The knowledge, skills and abilities as indicated below are normally acquired through the successful completion of a high school diploma (or equivalent).
</li><li>A minimum of two years of experience in a hospital or physician practice business office is required.
</li><li>Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills required.</li>
<li>A medical terminology course must be successfully completed prior to employment.
</li><li>Associate's degree preferred.
</li><li>Medical prior authorizations or claims experience in a managed care setting and CHAA certification are highly preferred.</li>
</ul>
The Beacon Way
At Beacon Health System, our approach to care goes beyond clinical excellence because it&rsquo;s built on meaningful connections. Guided by our core values of Trust, Respect, Integrity, and Compassion, we strive to create an environment where patients feel heard, employees feel valued, and innovation thrives.
We call this commitment The Beacon Way&mdash;a six-point operating system that empowers every team member to lead with purpose, communicate clearly, cultivate talent, embrace performance improvement, leverage innovation, and build greatness through accountability. Whether at the bedside or behind the scenes, everyone at Beacon plays a role in moving health forward.</div> 
</div>
</div></div></div> 
Location: Beacon Health System &middot; Verification of Benefits 
Schedule: Full-time, Day, 0830-5pm M-F</div>

Patient Access Insurance Specialist, Verification of Benefits Department, Full-Time Days

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