Insurance Specialist I - REMOTE

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 admission or observation status per payor guidelines for inpatient and observation services.

Performs other duties as assigned.

Complies with all policies and standards.

This is a remote position.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required: Education: H.S. Diploma or GED Experience: 0-1 years of experience in insurance verification, medical billing, or healthcare revenue cycle

Education: H.S. Diploma or GED

Experience: 0-1 years of experience in insurance verification, medical billing, or healthcare revenue cycle

Knowledge, Skills and Abilities:

Strong knowledge of insurance plans, authorization requirements, and medical necessity guidelines.

Proficiency in Microsoft Office Suite and healthcare information systems (e.g., EMR, eligibility portals).

Excellent attention to detail and organizational skills.

Strong communication and interpersonal skills to interact effectively with patients and healthcare professionals.

Ability to work in a fast-paced environment and manage multiple priorities effectively.

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

The Sarasota SSC operates in support of our hospitals and patients and our commitment is to provide them with exemplary revenue cycle services defined by outstanding customer service and superior revenue cycle performance. SSC Sarasota supports facilities located primarily in Florida, Georgia, Indiana, and Pennsylvania.

Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

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