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Company Contact Info

  • Palos Park, IL 60464

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Managed Care Specialist

Heart Care Centers of Illinois • Palos Park, IL

Posted 29 days ago

Job Snapshot

Full-Time
Travel - None
Experience - At least 2 year(s)
Degree - High School
Competitive Pay and Benefits
Healthcare - Health Services, Managed Care
Health Care, Insurance
Relocation - No
75+

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Job Description

Heart Care Centers of Illinois, a multi-site network of cardiovascular providers, currently has an opening for an Insurance Specialist / Managed Care Specialist at their Palos Park, IL location.  As part of a small team, the Managed Care/Insurance Specialist will be responsible for the overall processing of insurance verifications, referral/pre-certification/pre-determination requests and managed care contracts received via phone call, in person, and/or per request of physician/nurse and other HCCI staff.  Our ideal candidate will possess excellent customer service and time management skills, with the ability to prioritize a demanding work load.

 

Additional responsibilities include:

 

  • Prioritizes and processes incoming Insurance Verifications, Referrals, and Prior Authorization requests
  • Refers authorization requests that require clinical judgment to Prior Authorization Supervisor
  • Verifies member/patient eligibility and enters information into IDX
  • Supports Prior Authorization and Referral Clinicians
  • Ensures insurance carrier documentation requirements are met and referral support documentation is filed in patient records
  • Identifies and informs callers of network providers, services, and available member benefits
  • Informs providers of patient service decisions
  • Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes
  • Maintains general understanding of application sections of evidence of coverage, handbooks, etc.

Job Requirements

  • 2+ years experience working with Insurance Verification, Insurance Authorizations, or Specialist Referrals
  • Experience with Health Plan Utilization/Insurance Claims departments required
  • Knowledge of Government Payor Regulation, Compliance Policies, Medical Terminology and Coding preferred
  • MS Excel skills required
  • High School Diploma required, Associate’s degree preferred

 

Heart Care Centers of Illinois offers a competitive salary, excellent benefits package, and a weekday only schedule.  If interested, please e-mail resume with salary requirements to [Click Here to Email Your Resumé].  Apply today!

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