Experience Inc. Jobs

POSITION PURPOSE

The AIC Insurance Case Manager functions as an integral member of a multidisciplinary clinical team which manages the care of patients. The AIC Insurance Case Manager will verify patient's health benefits and coverage for infusion services. Ensures accurate and complete verification of insurance benefits. Communicates insurance benefits to include any co-pay or co-insurance to the PAR/Admin Assistant. Works closely with Nurse Manager and Reimbursement team in providing and promoting customer service, process flow, operational integrity, quality care and process improvement along with high service standards. Represents self in a professional and ethical manner at all times.

QUALIFICATIONS/REQUIRED EDUCATION/TRAINING

Experience:

• Two (2) plus years of medical insurance case management experience required.
• Medical terminology and coding experience required.

Education:

• High school diploma or equivalent.

Preferred:

• Experience in a clinical specialty involving infusion therapy desirable.

Other Qualifications:

• A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.
• Must be able to assume a flexible work schedule.
• Strong organizational, communication and problem solving skills.
• Excellent internal and external customer service.

Interpersonal Skills:

• Must have excellent interpersonal skills in handling interactions with Palmetto Infusion staff, other agencies, groups, patients and families.

Technology Skills:

• Competent in use of company email as means of communication, accessing the company website to view company policies and electronic medical records.
• Competent in the use of company self-service payroll software (time and attendance, benefits, pay statements).
• Competent in the use of Microsoft Office products and the ability to navigate Internet Explorer. Proficient in typing, word processing (Microsoft Outlook/Express, Word, Excel), and familiar with office equipment.
• Proficient in the operation of CPR+.

Language Skills:

• This position requires a knowledge of, and sensitivity to, cultural and language differences.

Mathematical Skills:

• Must have the ability to perform basic mathematical computations. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

Reasoning Ability:

• There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues.

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 50 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.

Other Skills:

• Must be able to work as a team member and develop productive and cooperative working relationships with all members of the Palmetto Infusion team.

ESSENTIAL DUTIES, FUNCTIONS and RESPONSIBILITIES

• Performs insurance verification for new patients.
• Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
• Evaluation and financial appropriateness of new referrals.
• Provides timely acceptance and completion of new referrals.
• Re-verifies insurance prior to each visit.
• Obtains reauthorization as applicable.
• Complet s the Insurance verification form and ensures the document is scanned into the patient medical record.
• Contacts case management/third party administrator/payor representative.
• Maintains knowledge of reimbursement principles and pricing parameters.
• Understands Medicare coverage principles and requirements for denial letters.
• Identifies, coordinates/sends materials to be sent to payor source.
• Provides and documents on-going communication with payor case managers for updates/changes/authorizations.
• Performs all other duties as requested.
• Maintains courteous demeanor at all times.
• Communicates with peers, supervisors and other employees in a non-threatening manner.
• Takes initiative to present ideas and suggestions to leadership.
• Demonstrates ability to maintain calm under pressure.
• Demonstrates ability to cope with changing environment.
• Maintains knowledge and proficiency in medical practices through continuing education, staff meetings, and workshops, and home study.
• Participates in the orientation of other staff as requested.
• Supports the marketing efforts of PI by assisting the sales team and providing educational programs to referral sources as requested.
• Participates in Performance Improvement processes.
• Performs other duties as assigned.
• Complies with all federal, state, county, and municipal laws, rules, ordinances and regulations applicable to the nurse practice act in the performance of obligations herein, as well as with applicable PI policies and personnel qualifications.