Insurance Specialist

3 weeks ago

Cleveland, United States Cleveland Clinic Full time

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.

As an Insurance Specialist, you will be responsible for:

  • Performing insurance prescreening and verification of benefits for multiple business lines within Connected Care (such as but not limited to: Home Infusion, Hospice, Nursing and Respiratory Therapy).

  • Determining serviceability and making appropriate recommendations based on patient's insurance coverage.

  • Communicating with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients and families to ensure understanding of approved benefit levels.

  • Maintaining customer relationships and ensuring business objectives are met.

The ideal future caregiver is someone who:

  • Has a background working with medical insurance, coding and the revenue cycle.

  • Is detail-oriented.

  • Thrives working both independently and as part of a team.

  • Demonstrates a strong work ethic.

At Cleveland Clinic, we know what matters most. That's why we treat our caregivers as if they are our own family, and we are always creating ways to be there for you. Here, you'll find that we offer: resources to learn and grow, a fulfilling career for everyone, and comprehensive benefits that invest in your health, your physical and mental well-being and your future. When you join Cleveland Clinic, you'll be part of a supportive caregiver family that will be united in shared values and purpose to fulfill our promise of being the best place to receive care and the best place to work in healthcare.

Responsibilities:

  • Performs insurance prescreening and verification of benefits for multiple business lines within Connected Care (such as but not limited to: Home Infusion, Hospice, Nursing and Respiratory).

  • Determines serviceability and makes recommendations based on patient's insurance coverage which includes and not limited to: Identifying the need for and obtaining authorizations for service, calculating billable units for authorizations, understanding of the drug formularies, different therapies and the associated diagnoses with each and examination of referrals for adherence to the required/qualifying insurance regulations.

  • Communicates directly with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients and families to ensure understanding of approved benefit levels.

  • Maintains customer relationships and ensures business objectives are met.

  • Other duties as assigned.

Education:

  • High School Diploma / GED or equivalent required.

  • Related college course work in business, finance or accounting preferred.

  • Medical terminology and/or successful completion of a medical terminology class or commensurate experience required.

Certifications:

  • None required.

Complexity of Work:

  • Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.

  • Must be able to work in a stressful environment and take appropriate action.

Work Experience :

  • Minimum of 2 years of related experience in medical business office or medical insurance environment required.

  • Excellent organizational, verbal and written communication skills.

  • Detail oriented.

  • Ability to identify and resolve problems.

  • Ability to work under pressure and meet deadlines.

  • Customer service experience, excellent customer service focus and orientation.

  • Proficient computer knowledge and skills.

Physical Requirements:

  • Ability to communicate and exchange accurate information.

  • Ability to perform work in a stationary position for extended periods.

  • Ability to work with physical records or operate a computer or other office equipment.

  • In some locations, ability to travel throughout the hospital system.

  • In some locations ability to move up to 25 lbs.

Personal Protective Equipment:

  • Follows Standard Precautions using personal protective equipment as required for procedures.

Salaries [which may be] shown on independent job search websites reflect various market averages and do not represent information obtained directly from The Cleveland Clinic. Because we value each individual candidate, we invite and encourage each candidate to discuss salary/hourly specifics during the application and hiring process.

Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities

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