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- Palos Park, IL 60464
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Managed Care Specialist
Heart Care Centers of Illinois • Palos Park, IL
Posted 29 days ago
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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.
- 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!