Insurance Verification Specialist

Job Description

Job Description

Description :

Medix Infusion is seeking a dedicated and detail-oriented Insurance Verification Specialist to join our team. As an Insurance Specialist, you will verify insurance eligibility and benefits for infusion services, review medical necessity guidelines, and ensure accurate documentation.

You will also handle authorization, predetermination, and appeal requests, collaborating with Intake, Scheduling, Pharmacy, and Clinical departments to manage patient care efficiently.

Medix Infusion is a technology-driven healthcare platform enhancing patient care and access to infusion therapies, specializing in disease management and infusion pharmacy services for chronic and acutely ill patients, especially in underserved communities.

We offer personalized home and in-suite infusion therapies, ensuring convenience and comfort. Our expert team provides a comprehensive range of treatments, including anti-infectives, biologics, IVIG, and other injectables, making each patient’s journey as smooth as possible.

Key Responsibilities :

• Verify insurance eligibility and benefits via phone, fax, or payer portals.
• Ensure timely completion of insurance reviews and documentation in the EMR system.
• Review payer medical policies to confirm medical necessity, including Medicare and FDA guidelines.
• Obtain necessary documentation from medical providers to support medical necessity.
• Submit and follow up on appeal requests for denied authorizations.
• Coordinate with departments to prevent delays in patient care.
• Assist in training staff and attend departmental meetings as needed.

Required Qualifications :

• High School Diploma or equivalent.
• 3-5 years of experience in healthcare, pharmacy, or medical claims billing and coding, including prior authorization and appeals.
• 2 years of infusion experience preferred.
• Strong understanding of Medicare, Medicaid, and commercial payer policies.
• Excellent communication skills and attention to detail.
• Ability to work effectively in high-volume, quality-focused teams.

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, and reading. The employee must occasionally lift and / or move up to 30 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.

Why Join Us?

• Compassionate Team : Join a dedicated team focused on exceptional patient care.
• Supportive Environment : Thrive in a positive work culture with growth opportunities.
• Competitive Compensation : Enjoy a comprehensive benefits package and competitive pay.
• Excellent Culture : Rated highly by our employees (NPS Score).
• Patient-First Approach : We treat others as we want ourselves or our families treated.
• Integrity : We are committed to doing the right thing in all situations.
• Team-Oriented : Work in a collaborative environment with an emphasis on positive intent.
• Comprehensive Benefits : Health and life insurance, voluntary dental / vision insurance.
• Retirement Savings : 401(k) plan with company contributions.
• Paid Time Off : Enjoy paid holidays and vacation time.

Medix Infusion offers a dynamic work environment, opportunities for professional growth, rewarding career challenges, and competitive compensation.

We are an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status, or other characteristics protected by law.

Medix Infusion will only employ individuals who are legally authorized to work in the United States. Any offer of employment is conditioned upon the successful completion of pre-employment screenings.

Requirements :