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Insurance Verification Specialist

1 month ago

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

Medix Infusion is seeking an experienced Insurance Verification Specialist to join our team. As an Insurance Specialist, you will function as a liaison between a patient and/or caregiver and the healthcare provider. Insurance Specialists are trained to provide support for the patient’s access to therapy through Insurance Specialist support services in accordance with the program business rules and HIPAA regulations.


You will be responsible for ensuring customer satisfaction, providing accurate, concise updates on cases regularly as outlined in program training and on-demand based on the needs of the business. You will also be expected to attempt to provide resolution to all concerns before escalating to management. All of your actions must demonstrate respect for the rights of people you support and their decisions and choices. You will promote individuality, advocate on behalf of those you support when necessary, and learn each person’s preferred method of communication, demonstrating active listening, and always encouraging their communication. You will actively partner with the field team to ensure client satisfaction and support excellent customer service.


Medix Infusion offers personalized home and in-suite infusion therapy services for patients with chronic or acute conditions. Our expert team is dedicated to making each patient’s journey as smooth as possible. We provide medical infusion therapies, including anti-infectives, biologics, IVIG, and other injectable and infusion treatments.


Key Responsibilities:

  • Ensure compliance with the highest ethical standards and all company business policies. Maintain patient confidentiality through HIPAA compliance.
  • Demonstrate exceptional customer service to all callers, both internal and external.
  • Promptly answer phones with a courteous demeanor, using recommended verbiage.
  • Professionally handle incoming requests (via phone, fax, or email) from patients, caregivers, and other stakeholders to ensure that questions and/or issues are answered/resolved promptly.
  • Thoroughly and efficiently gather patient information to support patient access and deliver on any patient needs within allotted timelines.
  • Educate patients and/or caregivers on the reimbursement and dispensing process and provide case status where applicable to prevent the need for future contacts and document interactions through contact tracking.
  • Accurately transcribe information into the system, ensuring that we have the most updated demographics and personal details on file for each patient.
  • Accurately record and document treatment plans, case acceptances, and arranged treatments. Positively present financial arrangements/options to patients, adhering to practice protocol.
  • Mediate effective resolution for complex payer/pharmacy issues toward a positive outcome to de-escalate.
  • Proactively follow up with various contacts to ensure patient access to therapy.
  • Communicate clearly and effectively in both written and verbal formats.
  • Provide excellence in customer service and patient support in areas including initial intake, program enrollment, site of service-based product coverage, follow-up on prescription orders, system/process troubleshooting, communication, issue identification/resolution, and customer satisfaction.
  • Continuously evaluate and identify opportunities to drive process improvements that positively impact the patient’s experience.
  • Provide feedback to management to identify any process non-conformance and potential solutions.
  • Be present, engaged, and ready to work at the assigned shift time (an 8-hour shift between the hours of 7 AM and 7 PM, Monday-Friday).
  • Demonstrate and influence a culture of teamwork and collaboration.
  • Complete all Learning Management System requirements.

Required Qualifications:

  • Five or more years of healthcare and customer service experience.
  • 3-5 years of pharmacy and/or medical claims billing and coding work experience, with:
    • Experience and knowledge of prior authorization and appeal submissions.
    • Reviewing EOBs.
  • Bachelor’s degree preferred (5 to 10 years of equivalent work experience in lieu of a bachelor’s degree will be considered).
  • Clear knowledge of Medicare (A, B, C, D), Medicaid, and commercial payers’ policies and guidelines for coverage.
  • Demonstrated ability to provide exceptional customer service.
  • Demonstrated ability to work with high-volume production teams with an emphasis on quality.
  • Strong written, oral, and presentation skills with the ability to effectively communicate across multiple audiences at all levels.
  • Demonstrated ability to build partnerships and influence in a cross-functional, highly matrixed environment.
  • Strong detail orientation and capability of gathering, conducting, and evaluating analyses of program performance, identifying points of improvement, and developing clear and compelling solutions and strategies from the findings.
  • Must be able to perform all the essential functions of the role 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.


Reasons to Work at Medix Infusion:

  • Excellent culture as rated by our employees (NPS Score).
  • Patient-first approach – treating others the way we want ourselves or our family treated.
  • Commitment to doing the right thing.
  • Team-oriented environment with an emphasis on positive intent.
  • Health insurance, life insurance, etc.
  • 401(k) savings plan with company contributions.
  • Voluntary dental/vision insurance.
  • Paid time off and paid holidays.

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: