Medical Insurance Specialist I

  • Organization

  • Shared Services Center - Sarasota Shared Services Center - Sarasota

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  • Full Time

Job Description

The Shared Services Center - Sarasota provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers.

Responsible for providing professional, accurate and timely insurance verification, ensuring authorization requirements are met per payor guidelines and preregistration for scheduled outpatient services. Additional responsibilities include accurate and timely notification of admission or observation status according to payor guidelines for inpatient and observation services, and accurate and timely indexing of all incoming orders.

Essential Duties and Responsibilities 

(List in order of importance or percentage of time spent on the particular responsibility – High to Low)

Verify insurance eligibility and benefits for scheduled services or service being provided

Accurate calculation of patient’s estimated responsibility for scheduled services

Determination of authorization/referral requirements according to payor guidelines

Validation of all authorizations/referrals according to established guidelines

Determine if scheduled service is medically necessary according to payor guidelines

Adherence to all documentation standards

Educate patients on insurance benefits and financial responsibility effectively

Ability to perform all other duties as assigned or requested

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