Insurance Specialist

POSITION DETAILS

Job Title: Insurance Specialist 

Status: This is a full-time, year-round, benefits eligible position.

Classification: Non-Exempt – Hourly

Schedule: M-F

Location: This is an in-office position, primarily based at our Avon location. 

Pay Range: $22.00-$24.00 / hr based on experience

POSITION OVERVIEW

The Insurance Specialist is responsible for securing pre-authorization for all scheduled surgeries, working closely with physicians and their teams. This role involves obtaining signed waivers, ensuring accurate documentation in patient charts, providing cost estimates, and collecting payments—including full payment for private pay patients, out-of-network insurance policies, deductibles, out-of-pocket expenses, and past due balances. The position requires strong communication skills, the ability to clearly explain complex insurance policies to patients, and a keen attention to detail to ensure accurate processing and compliance with insurance requirements.

CORE RESPONSIBILITIES

• Verify insurance benefits, eligibility, and network status for patients; promptly notify patients if their insurance is out of network.
  Re-check benefits and verify patient eligibility for policies not reviewed within the last 6 months.
• Contact insurance companies to verify pre-authorization requirements for procedures, including providing CPT codes and obtaining necessary authorization.
• If clinical information is required, fax clinical documents with a cover sheet to the insurance company and follow up for authorization or denial.
• Facilitate clinical communication as needed with the clinical team.
• Document all communications with insurance companies, adjusters, and patients in patient charts accurately and consistently.
• Provide accurate cost estimates to self-pay patients and collect payments in full.
• Obtain signed waivers prior to patient’s surgical date.
• Ensure compliance with patient privacy rights and confidentiality regulations, maintaining the highest level of patient data protection.
• Perform other related duties as assigned

MINIMUM QUALIFICATIONS

• Some college education preferred, or equivalent work experience.
  Minimum of two years’ experience in customer service, insurance, or healthcare settings.
• Strong knowledge of ICD-10 (International Classification of Diseases) and CPT (Current Procedural Terminology) codes is preferred; experience with orthopedic coding is a plus.
• Outstanding communication skills, both written and verbal, with the ability to interact professionally and build rapport with patients and colleagues.
• Excellent organizational skills, with the ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
• Strong interpersonal skills with a flexible and enthusiastic approach to teamwork.
• Proven ability to handle multiple responsibilities simultaneously and work efficiently under pressure.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and other relevant software applications

EMPLOYEE BENEFITS

We support our employees and their families with a robust, comprehensive benefits package to ensure life in the mountains doesn’t come with compromise. Come work with us to enhance your career and thrive in our mountain communities. Benefits eligible employees receive the following:

• Health, Dental and Vision Insurance with generous premium subsidies for you and your family.
• 401(k) Retirement with a Safe Harbor contribution amount equal to 4% of eligible compensation and discretionary profit-sharing contribution.
• Time Off Benefits: Staff receive 7 paid holidays annually. Employees can also earn up to 155 hours of PTO within their first year. In addition, employees accrue sick time of 1 hour per 30 hours worked, up to 48 hours / year.
• $1000 Wellness Bonus to encourage adopting and maintaining wellness and an active lifestyle.
• Tuition & Education Reimbursement to support continuing education and career advancement.
• Employee Assistance Program with confidential support from licensed professionals.
• Leave Benefits: The Steadman Clinic covers the cost of paid family medical leave in Colorado, basic life and AD&D, short- and long-term disability.