Insurance Specialist

Trinity Health; United States; Presencial; USD 32.000 - 47.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

Comprehensive benefits

Onsite fitness center

Tuition reimbursement

Daily pay option

Descripción de la vacante

Trinity Health Mid-Atlantic is seeking a part-time Insurance Specialist for per diem coverage in Utilization Management. You will support authorizations, extract data from medical records, and coordinate with nurses and providers to ensure timely approvals.

Responsibilities include processing admissions authorizations, communicating health plan benefits, and supporting quality improvement activities. On-site role with day shifts and a focus on compliant, cost-effective patient care.

Formación

• High School Diploma or Associate degree in a healthcare related field preferred.
• One year experience in a healthcare environment utilizing medical terminology or completed college level course in medical terminology.
• One year of case management, utilization review/billing or coding experience preferred.

Responsabilidades

• 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.
• Clarifies health plan medical benefits, policies and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
• Reviews service denials and gathers necessary supporting documentation from chart audits and follows up according to procedures.

Conocimientos

Medical terminology

Case management

Utilization review

Billing

Coding

Educación

High School Diploma / Associates degree in healthcare

Descripción del empleo

Employment Type

Part time

Shift

Day Shift

Description

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

What you will do

• 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 undefined

Education Requirements

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

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, utilization review/billing or coding experience preferred.undefined

Trinity Health Culture

Our staff know, understand, incorporate & demonstrate our Trinity Health Mission, Values, Vision, through their actions, behaviors, practices & decisions. Our Unit practice counsels, and open-door guiding principle gives all our employees a voice.

Professional Environment of Care

Practice in an environmentally safe, professional & healthy atmosphere. On campus parking for only $6/pay.

Benefits

Comprehensive benefit packages available through Trinity Health, including medical, dental, vision, paid time off, 403B, education assistance, onsite fitness center and option for daily pay.

Professional Development

We offer a robust education program, a generous tuition reimbursement allowance. Our collaborative culture encourages individual interests, while our leaders ensure we stay prepared for the evolving landscape of health care. We also support job share opportunities to promote flexibility, satisfaction, and continuous development.

Work/Life

Scheduling options to balance work/life/school and recreational calendars.

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.

Pay Range

$23.40 - $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

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.

Equal Opportunity Employer

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.

About Trinity Health

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs.

More Information

For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.