Insurance Verification / Authorization Specialist

InfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers by delivering ambulatory pumps and supplies, along with related clinical, biomedical and billing services, to practices and patients nationwide. With a comprehensive suite of services, InfuSystem improves clinician access to quality medical equipment and promotes patient wellness and safety while reducing the overall cost of infusion care.

InfuSystem offers Oncology, Pain Management and Wound Care therapies, including Negative Pressure Wound Therapy. The company's Durable Medical Equipment (DME) Services are composed of direct payer rentals, pump and consumable sales, and biomedical services and repair, including on-site and depot services. InfuSystem provides the sale, rental, lease and associated supplies, including infusion pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps, enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump tubing, ambulatory pumps, replacement pumps, disposable products, central venous access devices, closed system transfer devices, negative pressure wound therapy vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical services include both on-site and depot preventive maintenance, repair and warranty services, ranging from equipment inspections to extensive repairs, including compression device systems, defibrillators, EKG machines, electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs, light sources, modules, patient monitors, printers, pulse oximeters, telemetry transmitters and tourniquets - all completed to factory specifications.

Headquartered in Rochester Hills, Michigan, InfuSystem delivers local, field-based customer support and operates Centers of Excellence in Michigan, Florida, Kansas, California, Massachusetts, Texas and Ontario, Canada.

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 payors

Track 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 patients

Obtain authorization renewals, verify physician written orders are active, and certification of medical necessity is in place

Work closely with customer service team and sales representatives to secure clinical notes and other supporting documentation required to obtain authorizations timely

Verify authorization quantities and ensure effective dates are returned and processed correctly by the third-party payers, and loaded correctly in all systems

Organize work to avoid lost revenue due to filing limitations

Review 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 skills

Medical terminology

Good troubleshooting skills

Ability to work as a team

Ability to independently meet tight deadlines in a project-based atmosphere

Follows department processes and procedures

Highly motivated and detail-oriented

PERSONAL AND PROFESSIONAL ATTRIBUTES :

The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes :

Strong

work ethic

Sound

judgment

Proven written and verbal

communication

skills

Natural

curiosity

to pursue issues and increase expertise

Pursue and design

innovative

analytical performance metrics

The

courage

to promote and defend ideas and analyses

Passionate

about InfuSystem and serving customers and patients

Strives to make an

impact

on improving our business processes and results

Exemplary

honesty and integrity

Ability to collaborate effectively and work

selflessly

as part of a team

PHYSICAL 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 contribution

Health Savings Account (HSA)

Healthcare and Dependent Care Flexible Spending Accounts (FSA)

Dental and Vision premiums covered by InfuSystem

Life Insurance, STD & LTD

Paid Parental Leave

Adoption and Fertility Assistance

401(k) with a specified Company Match

Employee Stock Purchase Program

Tuition Assistance

Generous Paid Time Off plan

Employee Assistance Program

Competitive Pay

Employee Referral Bonus

Equal Opportunity Employer

This 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.