Insurance Case Manager

Palmetto Infusion Careers•Columbia, SC

2d•Onsite

About The Position

Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service – always delivering a warm and attentive health care experience that boosts patients’ state-of-mind, improves their health, and quality of life. At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers. For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities. The Case Manager is responsible for onboarding new patient referrals and managing the patient’s case through sending to scheduling. This position will obtain the needed information from the MD office, patient’s health benefits and coverage for infusion services. Ensures accurate and complete review of medical necessity and verification of insurance benefits and authorizations. Provides and promotes customer service, process flow, operational integrity, quality care and process improvement along with high service standards.

Requirements

High school diploma or equivalent.
1 year of healthcare experience or customer service experience.
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.
All employees must uphold the confidentiality of protected health information and follow all HIPAA policies.
This position has access to sensitive information and a breach of information may be grounds for immediate termination.

Responsibilities

Provides timely acceptance and completion of new referral including insurance verification, authorization, and Predeterminations as needed.
Obtains all needed information from MD office for insurance authorizations and clinical purposes.
Obtains patient data from referring physician office for support of medical necessity by reviewing payor medical policies and/or FDA guidelines providing the initial clinical review.
Documents in the EMR system the clinical rationale supporting the approval or denial of an infusion service based on the payer policy or FDA guidelines.
Communicates with peers, supervisors, and other PI team members in a non-threatening manner maintaining a courteous demeanor at all times.
Take initiative to 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.
Supports the marketing efforts of PI by assisting the sales team and providing education materials to the referral sources as requested.