What are the responsibilities and job description for the Insurance Specialist - Case Management - Full Time position at IRMC?
Essential Duties and Responsibilities
In this role you will be:
- Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to or during services.
- Obtain and manage initial and continued insurance authorizations for inpatient services, including admissions, procedures, and extended stays.
- Conduct insurance benefit investigations and communicate coverage details, patient responsibility, and financial obligations to patients, families, and hospital staff as appropriate.
- Review medical documentation to ensure medical necessity and compliance with payer guidelines.
- Coordinate with clinical staff, case management, utilization review, and physicians to obtain required clinical information for authorizations and appeals.
- Maintain accurate and timely documentation of insurance verification, authorizations, communications, and payer determinations in the electronic health record and billing systems.
- Serve as a liaison between the hospital, insurance companies, and patients to resolve coverage issues and payment discrepancies.
- Stay current on payer policies, reimbursement regulations, and changes in insurance requirements, including Medicare, Medicaid, and commercial plans.
- Assist with audits and compliance reviews related to insurance authorization and reimbursement.
- Ensure compliance with hospital policies, federal and state regulations, and HIPAA privacy standards.
- Perform other related duties as assigned to support revenue cycle operations and patient access services.
QUALIFICATIONS
Required:
- EDUCATION: High school graduate/degree or diploma in a health-related field
- EXPERIENCE:
- Experience with daily insurance portals that require verification process and barriers preferred
- Denials/appeals coordination as well as experience with software including, but not limited to, Davinician, Optum, HER, Challenger, Xsolis
- Minimum 1 year's clinical experience hospital or related setting preferred
- Basic computer skills and office equipment experience required
Day Shift; Monday - Friday
Plan Orientation to position October 2026