Benefits Specialist

Insurance Case Manager

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 and obtain authorization as needed. The Insurance Case Manager works closely with the clinical staff in coordinating patient care on established patients. Ensures accurate and complete verification of insurance benefits. Communicates insurance benefits to include any co-pay or co-insurance to the Patient Account Specialist. Works closely with clinical staff 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:

• High School Diploma or Equivalent.
• 2 years of experience obtaining 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.

Essential Functions:

• Obtains patient data from referring physician's office for support of medical necessity; ensures data integrity.
• Reviews payor medical policy to determine medical necessity based on payor guidelines and/or FDA indications.
• Utilizes Insurance Payors principles and requirements to determine coverage for all patients.
• Re-verifies insurance prior to each visit for existing patients.
• Obtains initial authorization and reauthorization as applicable.
• Completes the insurance verification in the EMR software and ensures the documentation obtained from the payor's website is scanned into the patient's medical record.
• Obtains a Letter of Medical Necessity (LMN), when required, from select payors.
• Identifies and coordinates materials to be sent to the payor for coverage determinations.
• Provides and documents ongoing communication with payor case managers for updates/changes/authorizations.
• Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, workshops, and home study.

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

Patient Advocacy Statement:

At Palmetto Infusion, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount. We understand that every interaction, every decision, and every effort contribute to the quality of care our patients receive.

Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates "The Palmetto Experience" a standard of excellence that defines us and enriches the lives of those we serve.

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.

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.

Equal Opportunity EmployerThis employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.