Insurance Specialist

• Insurance Specialist - St. Josephs Health Syracuse NY

  Position Summary:

  The Insurance Specialist under general supervision, supports the administrative requirements for Utilization Management and works collaboratively with Utilization Management/Concurrent Review Nurse, physicians, staff and other health care professionals. Interacts with internal and external providers to review and monitor members' utilization of health care services with the goal of maintaining high-quality cost-effective care. Works collaboratively with staff to obtain information from clinical reviews and medical records in order to provide the appropriate communication for authorization of medical services and procedures. Collaborates on system-wide quality improvement/performance improvement.

  Initiates and ensures authorizations for all admissions
  • Extracts meaningful data from the medical record of identified patients
  • Processes electronic communications within identified process standards
  • Actively participates in quality activities by communicating and coordinating with the care management team in the development of tools for optimal consumer outcomes and report findings
  • Upon identification of possible concurrent denials, forwards information to the appropriate Utilization Management/Concurrent Review Nurse within identified process standards
  • Reviews any service denials and gathers necessary supporting documentation from chart audits and follows up according to procedures
  • Provides external notifications of discharges and external post-acute transfers
  • Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies
  • Actively participates in the discussion and notification processes that result from the clinical utilization reviews with the facilities

  Per Diem- Insurance Specialist to assist with authorizations for Substance abuse and Mental Health Service lines

  Position Highlights:

  Quality of Life: Where career opportunities and quality of life converge.Advancement:  Strong orientation program, generous tuition allowance and career developmentWork/Life:  Positions and shifts to accommodate all schedules.

  Education Requirements:

  High School Diploma / Associates degree preferred in a healthcare related field.

  Experience Requirements:

  One year experience in a healthcare environment utilizing medical terminology or have completed a college level course in medical terminology.One year of case management or utilization review/billing or coding experience.One year of experience in coding/medical records/billing or healthcare related fieldOne year of case management or utilization review, billing, or coding experience

  Please be aware for the safety and security of our colleagues and patients all new employees are required to undergo and pass all applicable state and federally mandated pre-employment screening requirements including:

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  Pay Range:$ $33.70
  Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

  Mission Statement:

  ·We, St Joseph's Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

  Vision:

  ·To be world-renowned for passionate patient care and outstanding clinical outcomes.

  Core Values:

  ·In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are.

• Purpose

  Purpose

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.