InfuSystem
Insurance Verification / Authorization Specialist
InfuSystem, Rochester Hills, Michigan, United States,
InfuSystem is a growing 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.
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.
SUMMARY:
The Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. The Specialist will interpret benefit information and is familiar with insurance terminology to identify and document the correct plan. This position will request authorizations on payer websites, through fax submissions or over the phone and is responsible for follow-up, documentation, and re-authorizations as necessary.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
Responsibilities include initiating, following up, and securing authorizations sent to third-party payorsTrack and follow up on all pending authorizations within 7 - 14 days depending upon payer guidelines to expedite the claims process.Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patientsObtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in placeWork closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timelyVerify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systemsOrganize work to avoid lost revenue due to filing limitationsReview 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.Other duties as assigned.QUALITY AND QUANTITY OF WORK
Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.
SUPERVISORY RESPONSIBILITIES:
There are no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.Organizational skillsMedical terminologyGood troubleshooting skillsAbility to work as a teamAbility to independently meet tight deadlines in a project-based atmosphereFollows department processes and proceduresHighly motivated and detail-orientedPERSONAL AND PROFESSIONAL ATTRIBUTES:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
Strong
work ethicSound
judgmentProven written and verbal
communication
skillsNatural
curiosity
to pursue issues and increase expertisePursue and design
innovative
analytical performance metricsThe
courage
to promote and defend ideas and analysesPassionate
about InfuSystem and serving customers and patientsStrives to make an
impact
on improving our business processes and resultsExemplary
honesty and integrityAbility to collaborate effectively and work
selflessly
as part of a teamPHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE:
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
Health plan options that include an employer contributionHealth Savings Account (HSA)Healthcare and Dependent Care Flexible Spending Accounts (FSA)Dental and Vision premiums covered by InfuSystemLife Insurance, STD & LTDPaid Parental LeaveAdoption and Fertility Assistance401(k) with a specified Company MatchEmployee Stock Purchase ProgramTuition AssistanceGenerous Paid Time Off planEmployee Assistance ProgramCompetitive PayEmployee Referral BonusSpot Bonus Program
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.
SUMMARY:
The Verification/Authorization Specialist is responsible for verifying patient eligibility and benefit information. The Specialist will interpret benefit information and is familiar with insurance terminology to identify and document the correct plan. This position will request authorizations on payer websites, through fax submissions or over the phone and is responsible for follow-up, documentation, and re-authorizations as necessary.
IN THIS ROLE, THE IDEAL CANDIDATE WILL:
Responsibilities include initiating, following up, and securing authorizations sent to third-party payorsTrack and follow up on all pending authorizations within 7 - 14 days depending upon payer guidelines to expedite the claims process.Process authorizations electronically, utilizing payer portals, fax, or telephone working with the payers to secure authorizations retrospectively and/or requesting single case agreements for out of network patientsObtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in placeWork closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timelyVerify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systemsOrganize work to avoid lost revenue due to filing limitationsReview 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.Other duties as assigned.QUALITY AND QUANTITY OF WORK
Team members will be responsible for hitting regular productivity targets with a high level of quality. Quality audits will be performed on a regular basis and feedback and education will be provided to the team member to help support growth and development.
SUPERVISORY RESPONSIBILITIES:
There are no supervisory responsibilities
THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS:
Associate degree (A. A.) or equivalent; two to four years related experience and/or training; or equivalent combination of education and experience.Organizational skillsMedical terminologyGood troubleshooting skillsAbility to work as a teamAbility to independently meet tight deadlines in a project-based atmosphereFollows department processes and proceduresHighly motivated and detail-orientedPERSONAL AND PROFESSIONAL ATTRIBUTES:
The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes:
Strong
work ethicSound
judgmentProven written and verbal
communication
skillsNatural
curiosity
to pursue issues and increase expertisePursue and design
innovative
analytical performance metricsThe
courage
to promote and defend ideas and analysesPassionate
about InfuSystem and serving customers and patientsStrives to make an
impact
on improving our business processes and resultsExemplary
honesty and integrityAbility to collaborate effectively and work
selflessly
as part of a teamPHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPREHENSIVE BENEFIT PACKAGE:
At InfuSystem, we give our employees the tools to succeed both on and off the job. Our generous benefits package provides comprehensive coverage to help you protect your health and earning power and prepare for the future. In addition, we offer perks and programs that help you grow in your career and make InfuSystem a great place to work!
Health plan options that include an employer contributionHealth Savings Account (HSA)Healthcare and Dependent Care Flexible Spending Accounts (FSA)Dental and Vision premiums covered by InfuSystemLife Insurance, STD & LTDPaid Parental LeaveAdoption and Fertility Assistance401(k) with a specified Company MatchEmployee Stock Purchase ProgramTuition AssistanceGenerous Paid Time Off planEmployee Assistance ProgramCompetitive PayEmployee Referral BonusSpot Bonus Program