Insurance Verification & Authorization Specialist

Rush University Medical Center; Chicago (IL); On-site; USD 24,000 - 38,000; Full time

Job summary

Rush University Medical Center in Chicago, IL is seeking an Insurance Verification and Authorization Specialist for Home Infusion Solutions (HIS). You will obtain complete patient data and process prior authorizations to facilitate care and services provided by HIS.

This role requires excellent communication, problem solving, and teamwork. You will support navigators, clinicians, and patients, ensuring accurate documentation and adherence to Rush policies.

Qualifications

• High School Diploma or equivalent required.
• 2 year experience with medical insurance authorization in infusion services or other healthcare profession.
• 1 year experience with PBM & Major medical prior authorizations
• Demonstrates basic knowledge of all technical skills associated with assigned duties
• Good problem solving skills
• Ability to work independently and quickly respond and resolve a wide range of problems.
• Excellent verbal and written communication skills
• Ability to communicate with others in a professional and helpful manner.
• Demonstrates ability to adapt to changing environment.
• Ability to work effectively with others as part of a team.
• Good organizational and time management skills
• Dependable in attendance and job performance.
• Team player with a positive attitude and work ethic

Responsibilities

• Obtains insurance verification and prior authorization based on initial patient referral data.
• Verifies patients’ insurance coverage. Recognizes and identifies various types of drugs and the billing requirements associated with them.
• Documents and verifies billing procedures, and other pertinent information related to the collection process.
• Recognizes various plan codes and what drugs are covered under these different plans.
• Determines patient’s drug coverage as major medical or PBM and follow appropriate path to obtain authorization and patient’s financial responsibility.
• Submits appeals for authorization denials.
• Serves as resource to navigators regarding insurance coverage guidelines.
• Communicates financial responsibilities and generates patient information packets prior to onset of service.
• Assists patient’s with obtaining manufacturer co-pay assistance when appropriate.
• Prepares patient Start of Care Checklist with inter-disciplinary coordination.
• Performs other duties as assigned.

Skills

Communication skills

Problem solving

Teamwork

Time management

Organizational skills

Education

High School diploma or equivalent

Associate’s degree

Tools

Microsoft Office

Office equipment

Job description

Rush University Medical Center in Chicago, IL is seeking an Insurance Verification and Authorization Specialist for Home Infusion Solutions (HIS). You will obtain complete patient data and process prior authorizations to facilitate care and services provided by HIS.

This role requires excellent communication, problem solving, and teamwork. You will support navigators, clinicians, and patients, ensuring accurate documentation and adherence to Rush policies.