Job Summary
The Insurance Specialist I is responsible for verifying insurance eligibility and benefits, ensuring authorization requirements are met, and completing pre-registration processes for scheduled outpatient and inpatient services. This role ensures compliance with payor guidelines and provides timely and accurate communication with patients, providers, and medical office staff. The Insurance Specialist I supports the financial clearance process by educating patients on insurance benefits and financial responsibilities while maintaining high standards of accuracy and professionalism.
As an Insurance Specialist I at Community Health Systems (CHS) – SSC Sarasota, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical insurance, dental insurance, vision insurance, PTO, 401K, sick time, holidays, and bonus where eligible.
Essential Functions:
- Verifies insurance eligibility and benefits for scheduled and unscheduled services to ensure coverage and compliance with payor requirements.
- 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.
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
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. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
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