Insurance Verification and Authorization Specialist

1 month ago

Grand Rapids, United States Infusion Associates Full time

**Job Title**:Insurance Verification and Authorization Specialist

**Department**: Reimbursement

**Location**:Grand Rapids, MI

**FLSA Status**: Non-Exempt (Hourly)

**Manager Title**: Authorization Manager

**About Us**

Infusion Associates is multi-specialty infusion provider group with multiple sites across the Midwestern United States and poised for rapid growth. Our sites support specialty physician services, infusion therapy, and leading
- edge research on new medications for complex and rare disease states. Our service model makes it easy for patients to receive intravenous therapies 365 days a year with the support of physicians, advance practice providers, nursing, and pharmacy services. Our focus is always to provide a high-quality, low cost, exceptional patient experience at every interaction.

**Position Summary**: Performs day to day Insurance Verification and Prior Authorization activities to support the Revenue Cycle and to ensure reimbursement for services in a timely and accurate manner.

**Essential Functions & Responsibilities**

1. Verify insurance eligibility and benefits prior to visit.

2. Verify coverage of ordered services by calling payers or by obtaining the information using payer portals.

3. Verify appropriate reimbursement for ordered services by reviewing payer fee schedule.

4. Works with insurance companies to obtain the necessary prior authorizations and/or pre-certifications for services prior to patient visits.

5. Maintains current knowledge of payer policies and requirements.

6. Provide an accurate estimate of patient’s financial responsibility with each order.

7. Answers requests from patients, payers and other departments related to coverage of infusion services and prior authorizations.

8. Resource to team members and other departments related to insurance benefits and prior authorizations.

9. Actively participates in daily team huddles.

10. Other duties and projects as assigned.

**Knowledge, Skills & Abilities**:
1. 2 years related multi-site, multi
- state Revenue Cycle experience and/or training; or equivalent combination of education and experience.

2. High School Diploma or equivalent.

3. Proficiency in Microsoft Office, including Outlook, Excel, Word, Teams and SharePoint.

4. Ability to work efficiently and effectively under tight deadlines and high work volume.

5. Knowledge of infusion drugs a plus

6. Experience with Veradigm PM and/or Onco EMR a plus.

7. Knowledge of medical billing and coding.

8. Excellent problem-solving skills.

9. Strong analytical, accounting, and mathematical skills.

10. Strong, positive interpersonal and communication skills.

11. Proficient typing skills.

12. Attention to detail is essential in this role.

13. Excellent customer service skills

**Physical Requirements/Working Conditions**:

- Physical Requirement - Hearing (Frequently)
- Physical Requirement - Sitting (Frequently)
- Physical Requirement - Standing (Occasionally)
- Physical Requirement - Talking (Frequently)
- Physical Requirement - Walking (Occasionally)
- Physical Requirement - Near Vision (Constantly)
- Physical Requirement - Color Discrimination (Frequently)
- Physical Requirement - Use of keyboard, mouse and/or computer equipment (Constantly)
- Occupational Exposure/Risk Potential - Inside office environment (Applicable)
- Mental Requirement - Ability to multitask without loss of efficiency or accuracy, including the ability to perform multiple duties from multiple sources.
- Mental Requirement - Ability to work and sustain attention with distractions and/or interruptions.
- Mental Requirement - Ability to interact appropriately with a variety of individuals including customers/clients.
- Mental Requirement - Ability to understand, remember and follow verbal and written instructions.
- Mental Requirement - Ability to work effectively and efficiently in high stress and conflict situations.
- Mental Requirement - Ability to perform under stress and/or in emergencies.

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance

Weekly day range:

- Monday to Friday

**Education**:

- High school or equivalent (required)

**Experience**:

- Insurance verification: 1 year (preferred)
- Prior Authorization: 1 year (preferred)
- Knowledge of Infusion Drugs: 1 year (preferred)
- Allscripts PM: 1 year (preferred)
- Medical Billing or Prior Authorization: 1 year (required)

Work Location: In person

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