Insurance Specialist

Insurance SpecialistCenterpoint - Georgetown Kentucky Bariatrics Institute is operated jointly with Lifepoint Health. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As an Insurance Specialist joining our team, you're embracing our promise to provide superior patient care that exceeds industry standards as well as patient expectations. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.Fundamental to providing great care is supporting and rewarding our team. In addition to your base compensation, this position also offers:Health (Medical, Dental, Vision) and 401K Benefits for full-time employeesCompetitive Paid Time OffEmployee Assistance Program – mental, physical, and financial wellness assistanceTuition Reimbursement/Assistance for qualified applicantsAnd much more...An Insurance Specialist is responsible for verifying insurance eligibility and benefits, obtaining prior authorizations and referrals, tracking payer requirements, coordinating insurance approvals, and supporting patients through the process for bariatric surgery and medical weight management services. This position serves as a liaison between patients, providers, insurance companies, and referring offices to facilitate timely access to care.Perform insurance verification, eligibility, benefit review, and prior authorization activities for bariatric surgery and medical weight management servicesReview insurance plans to determine coverage requirements, exclusions, referrals, and medical necessity criteriaObtain required prior authorizations and referrals from insurance carriersSubmit clinical documentation and supporting records to insurance companies as requiredMonitor authorization status and follows up with payers to ensure timely determinationsDocument authorization activity and insurance updates accurately within the electronic medical recordCommunicate authorization approvals, denials, and pending requirements to providers, staff, and patientsEducate patients regarding insurance requirements, benefit coverage, and authorization processesCoordinate appeals and reconsideration requests for denied services when appropriateMaintain current knowledge of payer policies, bariatric surgery coverage criteria, and medical weight management requirementsCommunicate with insurance representatives regarding authorization requirements, documentation requests, and claim-related questionsWork closely with providers, clinical staff, scheduling personnel, and referring offices to facilitate patient progression through the programTrack and maintain insurance-related documentation in accordance with organizational policiesSupport workflow improvement initiatives related to insurance processing and patient accessAssist with patient inquiries regarding insurance coverage and authorization statusQualifications & Requirements:Education: High School Diploma or equivalent requiredAssociate degree or healthcare-related education preferredRequires critical thinking skills, decisive judgment, and the ability to work with minimal supervisionMust be able to work in a fast-paced environment and take appropriate actionMust be able to function effectively in a multi-task settingStrong organizational, communication, and customer service skillsWorking knowledge of managed care plans, commercial insurance, Medicare, Medicaid, and third-party payersProficient in Microsoft Office applications and electronic medical recordsOne year of insurance authorization, insurance verification, medical office, revenue cycle, or related healthcare experience requiredPrior authorization experience preferredBariatric surgery or surgical specialty experience preferredSchedule: Full Time / DayEEOC StatementCenterpoint - Georgetown Kentucky Bariatrics Institute is an Equal Opportunity Employer Centerpoint - Georgetown Kentucky Bariatrics Institute is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.