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Insurance Verification Specialist

2 months ago

Rochester Hills, Michigan, United States InfuSystem Full time
Job Summary

InfuSystem is a leading healthcare service provider specializing in infusion pumps and related products and services for patients in hospitals, clinics, ambulatory surgery centers, and other major service centers. We provide direct payer rentals, pump and consumable sales, and biomedical services and repair, serving all 50 states and Canada. Headquartered in Rochester Hills, Michigan, we have Centers of Excellence in Kansas, California, Massachusetts, Texas, and Ontario, Canada.

Job Description

As a leader in our field, our mission is to provide quality infusion services to patients and medical practices, including a 24-hour clinical support hotline. Our team effort provides product management and clinical support to enhance the lives of our patients and the communities we serve. Service is always our highest priority; keeping the patients' health & safety at the center of everything we do.

Key Responsibilities
  • Verify patient eligibility and benefit information to ensure accurate claims processing.
  • Interpret benefit information and identify the correct insurance plan to ensure timely authorizations.
  • Request authorizations on payer websites, through fax submissions, or over the phone and follow up on pending authorizations to expedite the claims process.
  • Process authorizations electronically, utilizing payer portals, fax, or telephone, and work with payers to secure authorizations retrospectively and/or request single-case agreements for out-of-network patients.
  • Obtain authorization renewals, verify physician-written orders are active, and certification of medical necessity is in place.
  • Work closely with the customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timely.
  • Verify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers and loaded correctly in all systems.
  • Organize work to avoid lost revenue due to filing limitations.
  • Review and verify all insurance plans and confirm patient's eligibility and benefits specific to DME.
  • Review and interpret insurance group pre-certification requirements, ensuring that proper pre-authorizations have been obtained from the payer and documented in HDMS/OnBase.
  • Input the correct Payer Plan ID# and enter data into systems to ensure accurate billing for current and future services.
  • Determine the extent of liability for insurance plans, coordination of benefits, and personal responsibility.
Requirements
  • Associate degree (A.A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.
  • Organizational skills.
  • Medical terminology.
  • Good troubleshooting skills.
  • Ability to work as a team.
  • Ability to independently meet tight deadlines in a project-based atmosphere.
  • Follows department processes and procedures.
  • Highly motivated and detail-oriented.
Personal and Professional Attributes
  • Strong work ethic.
  • Sound judgment.
  • Proven written and verbal communication skills.
  • Natural curiosity to pursue issues and increase expertise.
  • Pursue and design innovative analytical performance metrics.
  • The courage to promote and defend ideas and analyses.
  • Passionate about InfuSystem and serving customers and patients.
  • Strives to make an impact on improving our business processes and results.
  • Exemplary honesty and integrity.
  • Ability to collaborate effectively and work selflessly as part of a team.