Insurance Specialist I - REMOTE

Community Health Systems, Inc.; United States; Remote; USD 36,000 - 54,000; Full time

Benefits offered by this job

Life Insurance

AD&D

Long-term disability

Short-term disability

Flexible spending accounts

EAP

PTO

Paid holidays

ICP

Medical insurance

Dental insurance

Vision insurance

Educational assistance

401(k)

Job summary

Community Health Systems, Inc. seeks an Insurance Specialist I to verify insurance eligibility and benefits, obtain required authorizations, and complete pre-registration for outpatient and inpatient services.

You will educate patients on financial responsibilities and support the financial clearance process with accurate payer communications. This remote role requires strong knowledge of payor guidelines, excellent communication, and meticulous documentation to ensure compliant, efficient

Qualifications

• Education: H.S. Diploma or GED.
• Experience: 0-1 years in insurance verification, medical billing, or healthcare revenue cycle.

Responsibilities

• Verifies insurance eligibility and benefits for scheduled and unscheduled services to ensure coverage and payor compliance.
• Calculates patient’s estimated financial responsibility for scheduled services.
• Ensures authorizations and referrals meet payor guidelines.
• Validates and documents authorizations and referrals per policy.
• Reviews medical necessity based on payor criteria.
• Maintains accurate records and communicates with patients and staff.
• Educates patients on coverage and financial responsibility.
• Processes and indexes incoming orders with proper documentation.
• Notifies admission status per payor guidelines for inpatient/observations.
• Performs other duties as assigned and complies with policies.
• This is a remote position.

Skills

Insurance plans

Authorization requirements

Medical necessity

MS Office

EMR systems

Attention to detail

Organizational skills

Communication skills

Interpersonal skills

Fast-paced environment

Education

High School Diploma or GED

Tools

Microsoft Office Suite

Healthcare IT systems

EMR

Job description

• Life Insurance/Accidental Death and Dismemberment
• Long-Term and Short Term Disability
• Medical and Child Care Flexible Spending Accounts
• Employee Assistance Program (EAP)

Our Benefits

• PTO
• Paid holidays
• Employee Incentive Program (ICP)
• Group Medical, Dental, & Vision
• Educational Assistance
• 401(k) Plan
• Sick Time
• Life Insurance/Accidental Death and Dismemberment
• Long-Term and Short Term Disability
• Medical and Child Care Flexible Spending Accounts
• Employee Assistance Program (EAP)

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.

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.
• This is a remote position.

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. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

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