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Healthcare Insurance Coordinator

2 months ago

Columbia, South Carolina, United States Find Great People Full time

Join Our Team as a Healthcare Insurance Coordinator

We are collaborating with a prominent organization in the infusion and home health care sector, actively seeking a dedicated Healthcare Insurance Coordinator to enhance our team. This is a full-time position that comes with a comprehensive benefits package.

In this role, you will collaborate closely with clinical personnel to facilitate patient care. Your primary responsibilities will include verifying health benefits and coverage for infusion services, as well as securing necessary authorizations.

Key Responsibilities:

  • Gather patient information from referring physician offices to support medical necessity and ensure data accuracy.
  • Examine payer medical policies to assess medical necessity in accordance with payer guidelines and FDA indications.
  • Apply principles and requirements of insurance payers to ascertain coverage for all patients.
  • Re-confirm insurance details prior to each visit for returning patients.
  • Initiate and manage authorization requests as needed.
  • Complete insurance verification within the EMR system and ensure that documentation from payers is accurately recorded in the patient’s medical file.
  • Request a Letter of Medical Necessity (LMN) from specific payers when necessary.
  • Identify and organize materials required for payer coverage determinations.
  • Maintain ongoing communication with payer case managers to provide updates and manage authorizations.
  • Stay informed and proficient in medical practices through continuous education, staff meetings, workshops, and self-study.

Qualifications:
  • High School Diploma or Equivalent.
  • A minimum of 2 years of experience in medical insurance case management is required.
  • Proficient in using partner programs such as MS Outlook, Word, and Excel.

Work Environment:
  • In-person setting.