Insurance Specialist

Medix Infusion•Addison, TX

About The Position

Medix Infusion is seeking a detail-oriented and knowledgeable Insurance Specialist to join our patient services team. This position is responsible for verifying insurance benefits, obtaining prior authorizations, and ensuring accurate billing for infusion services under major medical benefit plans. The ideal candidate has a strong background in medical insurance processes, particularly in the infusion therapy space, and is adept at navigating complex payer guidelines and authorization requirements. Medix Infusion is a technology-driven healthcare platform enhancing patient care and access to infusion therapies, specializing in disease management and infusion pharmacy services for chronic and acutely ill patients, especially in underserved communities. We offer personalized home and in-suite infusion therapies, ensuring convenience and comfort. Our expert team provides a comprehensive range of treatments, including anti-infectives, biologics, IVIG, and other injectables, making each patient’s journey as smooth as possible.

Requirements

High school diploma or equivalent (Associate’s or Bachelor’s degree in healthcare or related field preferred).
Minimum of 2-3 years experience in insurance verification and authorizations, specifically for infusion therapy.
In-depth knowledge of major medical insurance plans, including Medicare, Medicaid, and commercial payers.
Experience using most major payer portals.
Strong understanding of CPT/HCPCS codes related to infusion and injectable therapies.
Excellent communication, organizational, and problem-solving skills.
Ability to work independently and prioritize multiple tasks in a fast-paced environment.

Nice To Haves

Familiarity with specialty pharmacy or home infusion services.
Knowledge of revenue cycle operations and medical billing processes.
Experience with benefit investigation and financial assistance programs.

Responsibilities

Verify patient insurance benefits for infusion services, with a focus on major medical coverage.
Secure and track prior authorizations for all infusion therapies, including specialty and biologic drugs.
Collaborate with referring providers, case managers, and internal clinical staff to collect required documentation.
Communicate authorization status, denials, and payer-specific coverage criteria to appropriate departments.
Utilize EMR systems and payer portals to enter and track insurance and authorization data accurately.
Review clinical notes and plan of care to align with payer requirements.
Follow up proactively on pending authorizations to prevent delays in patient care.
Appeal denied authorizations in collaboration with billing and clinical teams.
Maintain up-to-date knowledge of insurance policies, coding changes, and authorization procedures.
Support billing team in claim submission by ensuring proper coverage validation and documentation.
Provide excellent customer service to patients with insurance-related inquiries.