Insurance Specialist

Description

The Insurance Specialist is responsible for verifying 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.

DUTIES and 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.

QUALIFICATIONS and SKILLS:

· High School Diploma or equivalent.

· 2-3 years of experience in healthcare, pharmacy, or medical claims billing and coding, including prior authorization and appeals.

· 1 year 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.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those the 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. Equal Opportunity Employer that Prohibits Discrimination and Harassment of any kind. The organization is committed to the principles of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment.

· Noise level in the work environment is usually moderate

· The employee is exposed to outside weather conditions when traveling