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Health Insurance Specialist

4 months ago

Columbia, United States Find Great People | FGP Full time

Our client, an industry leader in infusion and in-home health care represented across the southeast is seeking an Insurance Case Manager to join their team


This role will work closely with clinical staff coordinating patient care and will verify patient’s health benefits and coverage for 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.


Responsibilities:

  • 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.
  • Utilizes Insurance Payors principles and requirements to determine coverage for all patients.
  • Re-verifies insurance prior to each visit for existing patients.
  • Obtains initial authorization and reauthorization as applicable.
  • 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.


Experience/Education:

  • High School Diploma or Equivalent
  • 2 years of medical insurance case management experience required
  • Proficient at partner programs (i.e.: MS Outlook, Word, Excel).


Benefits/Compensation:

  • $18-$23/hr based on experience
  • Comprehensive Medical Insurance
  • Dental and Vision Insurance
  • Company Life Insurance
  • Voluntary Life and Disability Insurance
  • Additional Voluntary Supplemental Plans
  • Flexible Spending Account (Medical and Dependent Care)
  • Health Savings Account
  • 401K Retirement Plan
  • Employee Assistance Program (EAP)
  • Employee Discounts
  • Ramsey SmartDollar Program
  • Referral Program
  • Tuition Assistance
  • Paid Time Off
  • 8 Paid Company Holidays