Insurance Verification Specialist

The Insurance Specialist is responsible for verifying insurance eligibility and benefits for infusion services. The Insurance Specialist reviews payer medical necessity guidelines and ensures proper documentation is on file to support therapy. The Insurance Specialist will submit and follow-up timely with authorization, predetermination, and appeal requests. The Insurance Specialist will work closely with the Intake, Scheduling, Pharmacy, and Clinical departments in managing patient care while promoting compassionate high-quality standards.

Work Experience Requirements

• Two years of insurance verification and authorization experience
• Two years’ experience in an infusion specialty preferred
• Experience working with all payer types, including Medicare, Medicaid, and commercial insurance companies

Duties and Responsibilities

• Verifies insurance eligibility and benefits via phone, fax, or payer portals.
• Provides timely completion of insurance review for established patients.
• Documents timely and accurately in the EMR system.
• Reviews payor medical policies to determine medical necessity and/or FDA guidelines including Medicare billing and coding guidelines.
• Coordinates with medical providers in obtaining necessary documentation to support medical necessity.
• Submits appeal request to payers for denied authorizations and follows-up on timely turnaround.
• Obtains authorization for infusion services for established patients.
• Knowledge of reimbursement policies.
• Completes follow-up tasks as assigned.
• Assures work is completed in a timely manner to prevent delays in patient care.
• Attends departmental meetings and in-services as requested.
• Assists with orientation and training of staff.
• Demonstrates courteous, compassionate, and professional behavior at all times.
• All other assigned duties.

REASONS TO WORK AT MEDIX INFUSION

• Excellent Culture as ranked by our own employees (NPS Score)
• We Put the Patient First – Treating Others the Way We Want Ourselves or Our Family Treated
• We Do the Right Thing…
• Team Matters – We Always Assume Positive Intent
• Health Insurance (Company pays approx. 70% of medical coverage chosen)
• Dental/Vision Insurance (voluntary)
• Paid Time Off – tiered plan based on tenure starting at 120 hours annually
• Paid holidays – 7 days per year
• $50,000 life insurance/$50,000 AD&D Employer Paid (additional Voluntary Life/AD&D products available)
• Disability income protection plan (optional)
• 401(k) savings plan and company match