Insurance Specialist

JOB DESCRIPTION

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

JOB DESCRIPTION:

All KHI employees are expected to perform their respective tasks and duties in such a way that supports KHI’s vision to be among the kindest, highest quality health systems in the country.

• Serves as Primary Contact for all payer requests for clinical information and utilization review decisions, in an efficient and professional manner.
• Serves as primary communicator to Case Managers, Physicians and Physician Advisors when clinical information is requested/received from the payor.
• Obtains and tracks appropriate information from Case Managers/Utilization Review Nurses and transmits to payers via fax, phone, or email, within the timeframe determined by the payer.
• Tracks cases to ensure authorization is received from the payer within 24 to 48 hours.
• Communicates authorization information to Case Manager/Utilization Review Nurse and updates information into the EMR and ARM module.
• Arranges and tracks Peer-to-Peers for physicians and works medical necessity denials in a timely manner.
• Demonstrates EMR and ARM module notes are concise and accurately reflect the activity and outcome.

Education: High School Diploma or GED Equivalent

Experience: N/A

Certification: N/A

License: N/A

• Experience with office machines (i.e., copier, fax, telephone), computer terminal/personal computer, software and payor portals (i.e., word processing, spreadsheets, etc.).
• Strong oral and written communication skills, must have excellent attention to detail as well as superb interpersonal skills in interacting with payers and healthcare team members.

Education: Associate degree or higher in business or healthcare related field

Experience: 2 years of experience in a healthcare setting performing related duties such as insurance claims, utilization review, doctor’s office, DME, etc.

Certification: N/A

License: N/A

• Expertise and knowledge of third-party payer requirements and regulations including Medicare/Medicaid, managed care payers, commercial insurance companies, worker’s comp, etc.
• Knowledge and expertise in developing and using data management tools such as Excel, Access, etc.

Exposure Category II: Expected duties have possible, but not routine, potential for exposure to blood, body fluids, or tissues.

Other potential Hazard(s):
Volatile/violent patients or family members

• Able to handle multiple priorities simultaneously
• Ability to sit for 3-5 hours per day
• Ability to stand for 3-5 hours per day
• Ability to walk for 3-5 hours per day

This job description applies to all KHI facilities and is representative of the essential job duties this position will perform. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Print Employee Name Employee Signature Date

Date Staff Position Description Created / Revised: 1/28/2026