Account Representative
2 weeks ago
Our client, an industry leader in infusion and in-home health care represented across the southeast is seeking an *Insurance Case Manager/Patient Account Specialist* to join their team This is a permanent opportunity offering benefits.
This role will work closely with clinical staff coordinating patient care and will verify patient’s health benefits and coverage for infusion services and obtain authorization as needed. This position ensures accurate and complete verification of insurance benefits and communicates insurance benefits to include any co-pay or co-insurance to the Patient Account Specialist.
*Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
* Reviews payor medical policy to determine medical necessity based on payor guidelines and/or FDA indications.
* Completes the insurance verification in the EMR software and ensures the documentation obtained from the payor’s website is scanned into the patient medical record.
* Obtains a Letter of Medical Necessity (LMN), when required, from select payors.
* Identifies and coordinates materials to be sent to payor for coverage determinations.
* Provides and documents on-going communication with payor case managers for updates/changes/authorizations.
* Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops, and home study.
*2 years of medical insurance case management experience required
* MS Outlook, Word, Excel).
#Job Type: Full-time
00 per hour
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