Description
Medix Infusion is seeking a detail-oriented and knowledgeable Insurance Specialist to join our patient services team. This position is responsible for verifying insurance benefits, obtaining prior authorizations, and ensuring accurate billing for infusion services under major medical benefit plans. The ideal candidate has a strong background in medical insurance processes, particularly in the infusion therapy space, and is adept at navigating complex payer guidelines and authorization requirements.
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:
- Verify patient insurance benefits for infusion services, with a focus on major medical coverage.
- Secure and track prior authorizations for all infusion therapies, including specialty and biologic drugs.
- Collaborate with referring providers, case managers, and internal clinical staff to collect required documentation.
- Communicate authorization status, denials, and payer-specific coverage criteria to appropriate departments.
- Utilize EMR systems and payer portals to enter and track insurance and authorization data accurately.
- Review clinical notes and plan of care to align with payer requirements.
- Follow up proactively on pending authorizations to prevent delays in patient care.
- Appeal denied authorizations in collaboration with billing and clinical teams.
- Maintain up-to-date knowledge of insurance policies, coding changes, and authorization procedures.
- Support billing team in claim submission by ensuring proper coverage validation and documentation.
- Provide excellent customer service to patients with insurance-related inquiries.
Required Qualifications:
- High school diploma or equivalent (Associate’s or Bachelor’s degree in healthcare or related field preferred).
- Minimum of 2-3 years experience in insurance verification and authorizations, specifically for infusion therapy.
- In-depth knowledge of major medical insurance plans, including Medicare, Medicaid, and commercial payers.
- Experience using most major payer portals.
- Strong understanding of CPT/HCPCS codes related to infusion and injectable therapies.
- Excellent communication, organizational, and problem-solving skills.
- Ability to work independently and prioritize multiple tasks in a fast-paced environment.
Preferred Skills:
- Familiarity with specialty pharmacy or home infusion services.
- Knowledge of revenue cycle operations and medical billing processes.
- Experience with benefit investigation and financial assistance programs.
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.