Insurance Authorization Specialist – Home Infusion

Palmetto Infusion Careers•Columbia, SC

12d•Onsite

About The Position

The Insurance Case Manager functions as an integral member of a multidisciplinary clinical team which manages the care of patients. The Insurance Case Manager will verify patient’s health benefits and coverage for infusion services. The Insurance Case Manager works closely with the Intake Coordinator to process new referrals timely. Ensures accurate and complete verification of insurance benefits. Works closely with Nurse Manager and Reimbursement team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards.

Requirements

High School Diploma or Equivalent.
2 years of experience managing insurance benefit verifications and authorizations.
Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.
Uphold the confidentiality of protected health information and follow all HIPAA policies.
Access to sensitive information and understanding that a breach of information may be grounds for immediate termination.

Responsibilities

Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
Verifies insurance utilizing both website and phone verifications.
Completes the insurance verification form and ensures proper documentation is scanned into the patient medical record.
Reviews payer medical policy to determine medical necessity based on payer guidelines and/or FDA indications.
Utilizes insurance payers policies and requirements to determine coverage.
Provides a comprehensive coverage and benefit summary, documentation, and on-going communication for updates, changes and authorizations.
Manages an on-going case load of patients on long-term therapies, including reauthorization as applicable.
Coordinates first payment and payment plans when necessary.
Obtains signed written orders (SWO) and letters of medical necessity (LMN) when required.
Demonstrates ability to maintain calm under pressure.
Acts as a primary point of contact on-call for after-hours and holidays as needed.