Insurance Verification / Authorization Specialist

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 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
• Spot Bonus Program