Insurance Case Manager

Palmetto Infusion Careers•Columbia, SC

About The Position

The Case Manager onboards new patient referrals and manages each case through submission to scheduling. The role obtains information from physician offices and verifies patients’ health benefits and coverage for infusion services. It ensures accurate and complete review of medical necessity, insurance benefits, and authorizations while supporting customer service, process flow, operational integrity, quality care, process improvement, and high service standards. The position works Monday through Friday, 8:00 AM to 5:00 PM. The role supports patient advocacy and must uphold the confidentiality of protected health information and comply with HIPAA policies.

Requirements

High school diploma or equivalent.
At least 1 year of healthcare or customer service experience.
Proficiency with partner programs, including MS Outlook, Word, and Excel.
Ability to cope calmly with an ambiguous, changing environment while under pressure.
Ability to work as a team member and develop productive, cooperative working relationships with all members of the team.

Responsibilities

Provide timely acceptance and completion of new referrals, including insurance verification, authorization, and predeterminations as needed.
Obtain information from physician offices for insurance authorizations and clinical purposes.
Obtain patient data from referring physician offices to support medical necessity; review payer medical policies and/or FDA guidelines and provide the initial clinical review.
Document in the EMR system the clinical rationale supporting approval or denial of an infusion service based on payer policy or FDA guidelines.
Communicate courteously and non-threateningly with peers, supervisors, and other team members.
Present ideas and suggestions for process improvements to the team lead, supervisors, and management.
Maintain knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
Support marketing efforts by assisting the sales team and providing educational materials to referral sources as requested.
Uphold the confidentiality of protected health information and follow HIPAA policies.
Put patients’ needs and well-being first and contribute to patient-centered care.