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Palmetto Infusion Services Insurance Case Manager - Home Infusion in Greenville, South Carolina

The Insurance Case Manager functions as an integral member of a multidisciplinary clinical team which manages the care of patients. The Insurance Case Manager will verify patient's health benefits and coverage for infusion services. The Insurance Case Manager works closely with the Intake Coordinator to process new referrals timely. 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/TRAININGTwo (2) plus years of medical insurance case management experience required.Medical terminology and coding experience required.Experience in a clinical specialty involving infusion therapy desirable.iPreferred:iGraduate from an accredited school of nursing with RN or LPN degree.Other QualificationsA 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.Must have excellent interpersonal skills in handling interactions with Palmetto Infusion staff, other agencies, groups, patients and families.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+.This position requires a knowledge of, and sensitivity to, cultural and language differences.Must have the ability to perform basic mathematical computations. Ability to apply concents such as fractions, percentages, ratios and proportions to practical situations.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.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.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 RESPONSIBILITIESPerforms 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.Completes 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 Med