Insurance Verification Specialist

1 month ago

Addison, United States Medix Infusion Full time
Job DescriptionJob DescriptionDescription:

Medix Infusion is seeking a dedicated and detail-oriented Insurance Verification Specialist to join our team. As an Insurance Specialist, you will act as a crucial liaison between referral sources and insurance providers, with some interaction with patients and caregivers. Your primary responsibilities will include verifying insurance eligibility and benefits for infusion services, reviewing payer medical necessity guidelines, and ensuring proper documentation is on file to support therapy. You will submit and follow up on authorization, predetermination, and appeal requests in a timely manner. Additionally, you will collaborate closely with the Intake, Scheduling, Pharmacy, and Clinical departments to manage patient care while upholding high standards of compassion and quality. Insurance Specialists are trained to onboard patients through the insurance approval process and provide support services for assistance program needs.


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.


Key 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.


Required Qualifications:

  • High School Diploma or equivalent.
  • Preferred 3-5 years of experience in healthcare, pharmacy, and/or medical claims billing and coding, including expertise in prior authorization and appeal submissions, and reviewing Explanation of Benefits (EOBs).
  • Preferred 2 years of infusion experience.
  • Comprehensive understanding of Medicare (Parts A, B, C, D), Medicaid, and commercial payers’ policies and coverage guidelines.
  • Proven track record of delivering exceptional customer service.
  • Experience working effectively in high-volume production teams with a strong focus on quality.
  • Excellent written, oral, and presentation skills, with the ability to communicate effectively across diverse audiences and organizational levels.
  • Demonstrated ability to build partnerships and influence in a complex, cross-functional environment.
  • Strong attention to detail, capable of conducting and analyzing program performance evaluations, identifying areas for improvement, and developing effective strategies.
  • Ability to perform all essential job functions with or without accommodations.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, and hear. There may be prolonged periods of sitting, keyboarding, and reading. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors, and staff.


Why Join Us?

  • Compassionate Team: Join a dedicated team focused on exceptional patient care.
  • Supportive Environment: Thrive in a positive work culture with growth opportunities.
  • Competitive Compensation: Enjoy a comprehensive benefits package and competitive pay.
  • Excellent Culture: Rated highly by our employees (NPS Score).
  • Patient-First Approach: We treat others as we want ourselves or our families treated.
  • Integrity: We are committed to doing the right thing in all situations.
  • Team-Oriented: Work in a collaborative environment with an emphasis on positive intent.
  • Comprehensive Benefits: Health and life insurance, voluntary dental/vision insurance.
  • Retirement Savings: 401(k) plan with company contributions.
  • Paid Time Off: Enjoy paid holidays and vacation time.

Medix Infusion offers a dynamic work environment, opportunities for professional growth, rewarding career challenges, and competitive compensation. We are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, or other characteristics protected by law.


Medix Infusion will only employ individuals who are legally authorized to work in the United States. Any offer of employment is conditioned upon the successful completion of pre-employment screenings.

Requirements:


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