Palmetto Infusion West Columbia , SC 29172
Posted 2 weeks ago
About Us:
Palmetto Infusion 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.
At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers.
For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities.
About the Role:
The Insurance Case Manager functions as an integral member of a multidisciplinary clinical team which manages the care of patients. The Insurance Case Manager will verify patient's health benefits and coverage for infusion services. The Insurance Case Manager works closely with the Intake Coordinator to process new referrals timely. Ensures accurate and complete verification of insurance benefits. Works closely with Nurse Manager and Reimbursement team in providing and promoting 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 of experience managing insurance benefit verifications and authorizations
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 team.
Essential Functions:
Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
Verifies insurance utilizing both website and phone verifications.
Completes the insurance verification form and ensures proper documentation is scanned into the patient medical record.
Reviews payer medical policy to determine medical necessity based on payer guidelines and/or FDA indications.
Utilizes insurance payers policies and requirements to determine coverage.
Provides a comprehensive coverage and benefit summary, documentation, and on-going communication for updates, changes and authorizations.
Manages an on-going case load of patients on long-term therapies, including reauthorization as applicable.
Coordinates first payment and payment plans when necessary.
Obtains signed written orders (SWO) and letters of medical necessity (LMN) when required.
Demonstrates ability to maintain calm under pressure.
Acts as a primary point of contact on-call for after-hours and holidays as needed.
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:
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.
Palmetto Infusion