Insurance Specialist

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will receive endless support and appreciation and build a rewarding career with one of the most respected healthcare organizations in the world.   

As an Insurance Specialist, you will perform insurance prescreening and verification of benefits for multiple business lines within Connected Care, including Home Infusion, Hospice, Nursing, and Respiratory Therapy. In this role, you will determine serviceability and provide appropriate recommendations based on patients’ insurance coverage. You will communicate with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients, and families to ensure a clear understanding of approved benefit levels.

A caregiver in this position works remotely from 8:30 a.m. – 5:00 p.m.

To be considered for this role, caregivers must reside in Ohio and within two hours of an Ohio Cleveland Clinic location.

A caregiver who excels in this role will:

• Perform insurance prescreening and verification of benefits for multiple business lines within Connected Care (such as but not limited to: Home Infusion, Hospice, Nursing and Respiratory).

• Determine serviceability and make recommendations based on patient’s insurance coverage.

• Identify the need for and obtain authorizations for service, calculate billable units for authorizations, understand the drug formularies, different therapies and the associated diagnoses with each and examination of referrals for adherence to the required/qualifying insurance regulations.

• Communicate directly with Pharmacy staff, Respiratory Therapy, Nursing Case Managers, patients and families to ensure understanding of approved benefit levels.

• Maintain customer relationships and ensures business objectives are met.

• Perform insurance verification for respiratory services and equipment.

• Verify coverage for CPAP, BiPAP, oxygen, nebulizers, suction equipment, and other respiratory-related durable medical equipment (DME).

• Process prior authorizations and ensure required documentation is obtained.

• Understand and apply payer guidelines to support accurate coverage determinations.

• Provide support for infusion authorization work as needed.

• Other duties as assigned.

Minimum qualifications for the ideal future caregiver include:

• High School Diploma / GED or equivalent

• Two years of related experience in medical business office or medical insurance environment

• Excellent organizational, verbal and written communication skills

• Ability to identify and resolve problems

• Ability to work under pressure and meet deadlines

• Customer service experience, excellent customer service focus and orientation

• Proficient computer knowledge and skills

• Medical terminology and/or successful completion of a medical terminology class or commensurate experience

Preferred qualifications for the ideal future caregiver include:  

• Related college course work in business, finance or accounting

• Insurance and Medicare verification experience

• Commercial insurance knowledge

• Medicare and Medicare product experience

• Prior authorization experience

• Understanding of payer requirements and guidelines

• Experience with EMR systems such as Epic

Physical Requirements:

• Manual dexterity to operate office equipment.

• May require periods of sitting, standing and the ability to walk to various locations throughout the Foundation to attend meetings; must have normal or correction vision to clearly communicate verbally by phone or in person.

Personal Protective Equipment:

• Follows Standard Precautions using personal protective equipment as required for procedures.

The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances.

Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption.

Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. 

If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/

Please review the Equal Employment Opportunity poster. 

Cleveland Clinic is pleased to be an equal employment opportunity employer.