Insurance Precertification/Reimbursement Specialist

About UsAt Sinai Health System d/b/a Sinai Chicago, we take health care personally. Excellence in health care is about more than medicine, technology, tests, and treatments-it is about truly caring for people with dignity and respect. We are dedicated to providing high-quality care for our community, our patients, and our caregivers. Position PurposeThe Insurance Pre-certification/Reimbursement Specialist is responsible for coordinating Admitting Department management policies and procedures in accordance with standards set by Sinai Chicago Medical Staff and applicable regulatory agencies. This role includes analyzing medical records to ensure appropriate documentation supporting the need for post-acute care services. The position works across the Sinai Chicago hospital network to provide insurance authorization services and clinical recommendations that support access to inpatient rehabilitation when appropriate. The Specialist plays a key role in denial prevention and management strategies to ensure eligible patients receive access to inpatient programs. Key Job ActivitiesCoordinate insurance precertification and admission review functions as outlined in the Schwab Hospital Admission Plan, including screening for medical necessity, eligibility, and appropriateness at preadmission and admission. Analyze insurance, governmental, and accrediting agency standards to determine criteria related to admission, treatment, and length of stay. Manage prior authorization and recertification processes via phone, fax, or electronic methods with third-party payers. Conduct complex case reviews to determine inpatient admission criteria. Implement efficient strategies to navigate insurance authorization processes. Capture and document denial management activities and outcomes to support data reporting and trend analysis. Drive denial management strategies to increase successful authorization outcomes. Managerial and Departmental SupportAssists the manager in the following areas: Supporting departmental and hospital-wide education initiatives. Reviewing and refining admitting department policies and procedures. Reviewing medical charts and composing insurance appeal letters on behalf of patients. Developing and maintaining positive working relationships with key insurance payers to improve access to inpatient services. Performing admission office duties as assigned by the supervisor. Diversity, Equity, and Inclusion CommitmentEmbraces Sinai Chicago's DEI mission by: Treating all individuals with dignity and respect. Expanding opportunities for underrepresented communities. Developing and supporting caregiver growth. Identifying and eliminating disparities. Taking action against injustice, bias, and racism. Honoring differences and fostering collaboration. Educating caregivers, patients, and the communities served. Restoring hope and freedom-together. Customer Service ResponsibilitiesDemonstrates excellence in customer service and professional behavior. Encourages, coaches, and models positive service standards. Promotes teamwork and open communication across departments. Handles confidential information discreetly and sensitively. Quality Improvement ResponsibilitiesIdentifies process improvement opportunities and contributes solutions. Promotes patient and family satisfaction and participates in service quality monitoring. Performs other duties as assigned. Education and ExperienceHigh School Diploma or equivalent required. Minimum of two (2) years of experience in insurance verification and authorization preferred. Knowledge and SkillsStrong written communication skills, including accurate spelling, grammar, and composition. Ability to interact professionally with clinical and administrative staff. Proficient in personal computer use for medical records and insurance verification. Experience with EPIC, OneSource, and Availity systems preferred. Certifications and LicensesValid driver's license with no restrictions. Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) certification preferred. BenefitsSinai Chicago offers a comprehensive benefits program designed to support caregiver health, wellness, and financial security, including: Medical, dental, vision, and prescription coverage Employer-paid life insurance and AD&D Supplemental life, short-term and long-term disability Health Savings Account (HSA) and Flexible Spending Account (FSA) Employee Assistance Program (EAP) Student loan assistance 403(b) retirement savings plan Eligibility varies by employment status and hours worked. Living the ValuesTeamwork: Collaborates to promote an inclusive and respectful work environment. Respect: Treats all individuals with dignity and fairness. Quality: Follows best practices and contributes to service improvement. Integrity: Acts ethically and holds self and others accountable. Safety: Promotes a safe environment for patients, visitors, and caregivers. Role Model: Demonstrates Sinai Chicago's values through daily actions.