Insurance Case Manager

About Us:

Palmetto Infusion/AccuRX provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service – always delivering a warm and attentive health care experience that boosts patients’ state-of-mind, improves their health, and quality of life.

About the Role:

The Insurance Case Manager is responsible for onboarding new patient referrals and managing the patient’s case through sending to scheduling. This position will obtain the needed information from the MD office, patient’s health benefits and coverage for infusion services. Ensures accurate and complete review of medical necessity and verification of insurance benefits and authorizations. Provides and promotes customer service, process flow, operational integrity, quality care and process improvement along with high service standards.

Schedule: Monday – Friday; 8:00 AM – 5:00 PM

Minimum Qualifications:

Experience/Education:

• High School Diploma or Equivalent
• 2 years experience of medical insurance case management experience required
• Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
• Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion/AccuRX team.

Essential Functions:

• Provides timely acceptance and completion of new referrals including insurance verification, authorization, and Predeterminations as needed.
• Obtains all needed information from the MD office for insurance authorizations and clinical purposes.
• Obtains patient data from referring physician’s office for support of medical necessity by reviewing payor medical policies and/or FDA guidelines providing the initial clinical review; Documents in the EMR system the clinical rationale supporting the approval or denial of an infusion service based on the payer policy or FDA guidelines.
• Communicates with peers, supervisors, and other PI team members in a non‐threatening manner maintaining a courteous demeanor at all times.
• Take initiative to present ideas and suggestions for process improvements to the team lead, supervisors, and management. Maintain knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops.
• Supports the marketing efforts of PI by assisting the sales team and providing educational materials to the referral sources as requested.

About the Benefits:

• Competitive Compensation
• Comprehensive Medical Insurance
• Dental and Vision Insurance
• Company Life Insurance
• Voluntary Life and Disability Insurance
• Additional Voluntary Supplemental Plans
• Flexible Spending Account (Medical and Dependent Care)
• Health Savings Account
• 401K Retirement Plan
• Employee Assistance Program (EAP)
• Employee Discounts
• Ramsey SmartDollar Program
• Referral Program
• Tuition Assistance
• Paid Time Off
• 8 Paid Company Holidays

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, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 25 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.

OTHER

All employees must uphold the confidentiality of protected health information and follow all HIPAA policies. This position has access to sensitive information and a breach of information may be grounds for immediate termination.

We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.