What are the responsibilities and job description for the Insurance Specialist II position at Shared Services Center - Sarasota?
Insurance Specialist II
2023-05-13Organization
Shared Services Center - Sarasota
Location SARASOTA, FL (Shared Services Center - Sarasota)Full Time- Department Business Office
- Field Finance and Accounting
Location SARASOTA, FL (Shared Services Center - Sarasota)
Department Business Office
Field Finance and Accounting
Full Time
Job Description
The Appeal Specialist II is responsible for managing and coordinating the workflow for the Appeal Team. This individual manages denial/appeal correspondence, assures accounts are assigned to the appropriate nurse for appeal review, and performs timely follow-up for appeal determinations. This individual also is responsible for accurately entering data into the appeal log. Quality work is imperative for the department to run efficiently.
Essential Duties and Responsibilities
(List in order of importance or percentage of time spent on the particular responsibility – High to Low
1.
Verify insurance eligibility and benefits for scheduled services or service being provided
2.
Accurate calculation of patient’s estimated responsibility for scheduled services
3.
Determination of authorization/referral requirements according to payor guidelines
4.
Validation of all authorizations/referrals according to established guidelines
5.
Determine if scheduled service is medically necessary according to payor guidelines
6.
Adherence to all documentation standards
7.
Maintain effective, professional communication with patients, physicians, medical office staff to ensure compliance with identified payor requirements
8.
Educate patients on insurance benefits and financial responsibility effectively
9.
Ability to perform all other duties as assigned or requested
Salary : $44,900 - $56,900