Insurance Admissions Specialist

Position Summary

The Admissions Specialist is responsible for supporting the admissions and insurance verification process for assigned clients and facilities. The role includes reviewing patient insurance coverage prior to admission, obtaining and maintaining required authorizations, updating patient insurance information, following up on open admission-related tasks, and helping ensure that patients are financially cleared in a timely and accurate manner. This position works closely with internal teams, clients, facilities, and the collections department to support efficient admissions and revenue cycle operations.

Key Responsibilities

• Review and verify admissions for assigned clients, facilities, or states in a timely manner.
• Verify patient insurance coverage and identify whether prior authorization is required before or at the time of admission.
• Initiate and follow up on prior authorization requests through the appropriate method, including payer portals, phone, or fax.
• Enter and maintain accurate insurance and authorization information in the applicable billing or patient management system.
• Monitor open tasks and follow up regularly to ensure outstanding items are resolved.
• Track authorization effective dates and expiration dates and complete authorization renewal or expiration reports as assigned.
• Complete recurring eligibility reviews for applicable insurance plans and patient populations.
• Review billing or charge reports after billing to confirm that patients requiring authorization have valid authorization on file.
• Work with the collections department to resolve claim issues related to eligibility, authorization, or admission information.
• Maintain payer-specific authorization requirements and document how authorization should be requested when required.
• Assist team members with admissions, insurance, and authorization questions and provide guidance when needed.
• Provide coverage for other team members when they are unavailable and prioritize time-sensitive tasks that cannot be delayed.
• Escalate coverage, authorization, eligibility, or operational issues when they may affect patient acceptance or reimbursement.
• Maintain clear and timely communication with internal departments, facilities, and clients.
• Identify opportunities to improve workflows, reduce unnecessary work, and increase productivity and accuracy.

General Expectations

• Maintain accuracy, professionalism, confidentiality, and timely follow-up in all assigned work.
• Follow client-specific and payer-specific procedures, recognizing that requirements may differ by client, facility, state, and insurance plan.
• Maintain organized documentation of completed work, outstanding issues, and follow-up activity.
• Meet departmental deadlines and communicate promptly when an issue may prevent timely completion.
• Support the overall goals of the organization by providing consistent and dependable service to clients and internal teams.

Required Skills and Qualifications

• Working knowledge of health insurance eligibility, benefits, prior authorization, and patient financial clearance processes.
• Strong attention to detail and ability to manage multiple patients, tasks, and deadlines.
• Ability to communicate effectively with insurance companies, facilities, clients, and internal departments.
• Strong organizational, follow-up, and problem-solving skills.
• Ability to learn and use billing systems, payer portals, spreadsheets, and other operational software.
• Experience with dialysis, healthcare admissions, medical billing, or revenue cycle operations is preferred.