Healthcare Specialist Job Description
Healthcare specialist
provides leadership for compliance with Federal and State regulations and regulatory standards regarding affirmative action, safety, The Joint Commission Readiness, and patient care.
Healthcare Specialist Duties & Responsibilities
To write an effective healthcare specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included healthcare specialist job description templates that you can modify and use.
Sample responsibilities for this position include:
Utilize Excel to verify information and report lists of daily accounts
Creating individual strategy for long term placement relationships fulfilling “one off” placement requirements for students
Provides guidance to members on open enrollment issues and benefit options
Connect with customers by phone and quickly develop a rapport to help the individual to navigate their benefit choices and options
Prepares reports and specifications
Providing appeals assistance for members with denied medical treatment or services claims, which includes advocating for members in the appeals process
Negotiating fees on behalf of the member
Researching denied claims ensuring proper coding
Educating members on the components of their benefit plan coverage
Research billing issues to determine the possible cause of the error ensuring to assist with claims resubmission as required to correct the issue
Healthcare Specialist Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Healthcare Specialist
List any licenses or certifications required by the position: HCCA
Education for Healthcare Specialist
Typically a job would require a certain level of education.
Employers hiring for the healthcare specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Medical, Education, Business, Healthcare, Associates, Business/Administration, Communication, Marketing, Science, Computer Science
Skills for Healthcare Specialist
Desired skills for healthcare specialist include:
Respiratory home care techniques and relevant respiratory therapy concepts
Implements emergency and safety procedures for classrooms
Labs and all learning environments
Ability to facilitate patient safety and quality improvement principals
Concepts and initiatives
Consultative skills to effectively deal with customers
EPA-RCRA
Excel
Joint Commission Standards
Desired experience for healthcare specialist includes:
Establish and maintain a network of key contacts within insurance carriers, federal and state offices, and the health insurance industry
Educate members on insurance plan provisions ensuring they have a full understanding of their plan
Research and evaluate appeals issues to determine the possible cause of the error ensuring to assist the client throughout the appeal process
Document all appeals issues thoroughly maintaining department files and appropriate databases
Assist in monitoring issue trends, escalating such trends to supervisor to determine appropriate actions necessary to eliminate future occurrences and improve service levels
Candidate is confident with public speaking duties
Healthcare Specialist Examples
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Healthcare Specialist Job Description
Job Description Example
Our growing company is looking to fill the role of healthcare specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for healthcare specialist
- Handle telephone calls to patient, surgeon, or facility to verify insurance information
- Communicate payer infrmation effectively to appropriate parties and departments
- Resolve problems that may arise whether internal or external with the utmost professionalism
- Provides follow up and ongoing training for IWSS service specifics for hospital staff and employees
- Looks for new opportunities to reduce cost and improve performance
- In partnership with the Integrated Waste Compliance Specialist, train hospital personnel on the regulatory requirements of the waste streams being managed
- Proactively looks for new ways or services to increase the profitability of the program
- On an ongoing basis, provides the customer quick resolution and follow-up on all projects and issues
- Research, analyze, present results, and recommend intelligent solutions to solve problems and address business challenges by applying a knowledge of healthcare claims analysis, critical-thinking skills, and healthcare experience/expertise
- Determining credibility and usability of claims data prior to delivery of analytic results
Qualifications for healthcare specialist
- Demonstrates knowledge of Microsoft Office Products
- Demonstrates knowledge of all hospital related waste streams
- Hazardous Materials and OSHA Regulations
- 2-4 years experience in insurance verification or patient registration
- Prior authorization/precertification experience prefered
- Previous experience with out of network providers prefered
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Healthcare Specialist Job Description
Job Description Example
Our growing company is hiring for a healthcare specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare specialist
- 1-3 years of experience or proven ability working as an analyst, preferably in the health care industry, particularly with administrative healthcare claims and provider data preferred
- Proven experience working with Medicare and Commercial paid claims data sets
- Reasonable experience with Structured Query Language (SQL) required
- Maintains an organized day-to-day work environment handling multiple projects simultaneously
- Interpreting regulations and identifying compliance requirements
- Assessing likely risks and recommending compliant solutions that support business goals and serving as an expert
- Supporting workforce education about compliance requirements
- Assisting with benefit interpretation and drafting policy language to reflect compliance and business-driven changes
- Occasional work outside of normal work hours
- Perform other duties as assigned within the scope of responsibilities and requirements of the job
Qualifications for healthcare specialist
- Minimum requirement is High School diploma, college degree preferred
- Knowledge of insurance plans and financial classes
- Ability to effectively communicate through verbal, phone, or written communication
- Excellent decision making abilities and effective problem solving skills
- Daily Responsibilities will include telephonic outreach to targeted providers to educate the providers on data validation regulatory requirements and to secure practice information
- The expectation is to make 40 outbound calls per day, 5 per hour, averaging 12 minutes each
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Healthcare Specialist Job Description
Job Description Example
Our company is growing rapidly and is looking for a healthcare specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare specialist
- Manages a lead list to meet enrollment goals
- Acts as a liaison between dialysis facilities, field operators and VillageHealth
- Consistently achieves metrics and goals set for the team, including enrollment rate and satisfaction scores
- Performs administrative tasks in support of enrollment operations
- Analyze and prioritize orders based on initial assessment of documentation and customer outreach
- Verify third party payer benefits and eligibility (online or telephonically)
- Review and analyze payer specific requirements and coverage criteria to determine required documentation and accurate billing criteria
- Call customer or field personnel to obtain missing documentation required for placement and/or billing
- Contact patient to coordinate delivery of product
- Follow-up post delivery to obtain any additional documentation to support billing criteria
Qualifications for healthcare specialist
- Candidate will be required to perform subsequent data entry of the providers updated practice information into our internal systems as needed, in addition to weekly reporting to CA leadership of telephonic outreach activities and compliance success
- Minimum of 1 year experience in behavioral healthcare related field
- Word and PowerPoint
- Candidate will be required to perform subsequent data entry of the providers updated practice information into internal systems as needed, in addition to weekly reporting to CA leadership of telephonic outreach activities and compliance success
- Experience in a diagnostics laboratory highly desired
- Medical ProFee Billing and CPC coding preferred
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Healthcare Specialist Job Description
Job Description Example
Our growing company is looking to fill the role of healthcare specialist. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for healthcare specialist
- Acts as a resource for Sales and other cross functional departments to provide order status and any other information
- Participates in any and all reasonable work activities as may be deemed suitable and assigned by management
- Regional healthcare specialist for assigned region & market
- Stimulate growth with target healthcare customers
- Evangelize the HP Healthcare value proposition for all product categories
- Maintain relationship with key customers and regional sales leaders focused on closing deals
- Collaborate with WW Healthcare team on strategic direction and insights driven from customers
- Develop training materials and conduct training classes and workshops
- Grasp a solid understanding of the Healthcare industry and the processes required on State Medicaid Fiscal Agent accounts
- Participates in the identification, documentation, analysis and validation of intermediate level business processes, systems, and solution requirements
Qualifications for healthcare specialist
- Familiarization with the imaging studio equipment and requirements
- 2+ years of imaging studio experience with strong desktop skills
- At least four years in a substantially similar position in a health care environment
- Basic knowledge of federal and state regulations and standards related to compliance in health care
- Basic knowledge of standard contract components and contract language
- Basic knowledge of compliance systems, processes and reporting
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Healthcare Specialist Job Description
Job Description Example
Our company is growing rapidly and is hiring for a healthcare specialist. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for healthcare specialist
- Make recommendations for policy / procedure changes
- Researches and evaluates components of solutions to problems
- Able to resolve / recommend action on less complex issues
- Applies knowledge of business unit processes to support requirements of business unit
- Participates in process review and improvement initiatives
- Establishes customer satisfaction by responding to requests for data / service in a timely and quality manner, interpreting circumstances
- Manage multiple assignments with minimal supervision
- Manage requests from customers, leaders, and corporate executives
- Must be able to travel frequently (up to 60%) with the occasional overnight stay
- Work with business users to understand their business processes
Qualifications for healthcare specialist
- Strong oral and written communication skills with the ability to communicate professionally, effectively and persuasively to diverse individuals and groups
- Ability to effectively prioritize multiple tasks and meet agreed-on deadlines
- Ability to speak and be understood in English
- Experience building relationships and collaborating with employees and customers
- Previous experience in communicating in writing and verbally with employees and customers at all levels of an organization
- Previous experience prioritizing multiple deadlines