Prior Authorization Specialist

Insurance Case Manager

Palmetto Infusion provides comprehensive ambulatory and home-based infusion services to both acute and chronically ill patients. Our centers care for people by providing patients and their families with a convenient, affordable, and safe place to receive infusion treatments. We strive for more than personal service always delivering a warm and attentive health care experience that boosts patients' state-of-mind, improves their health, and quality of life.

At Palmetto Infusion, we believe in creating an experience that goes beyond just a job. It's about being part of something bigger than yourself - a connected group of caretakers who work together to restore health and hope to our patients. We call it The Palmetto Experience, and we believe it's what sets us apart from other employers.

For our employees, The Palmetto Experience means we serve and support people in our purpose to restore health and hope, we build a culture of belonging and collaboration, we deliver on our promise to treat people with respect and empathy, and we strive to embrace change and search for new opportunities.

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. 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.

Schedule: Monday Friday; 8:00 AM 5:00 PM.

Minimum Qualifications:

• High School Diploma or Equivalent.
• 2 years of experience managing insurance benefit verifications and authorizations.
• Proficient at partner programs (i.e.: MS Outlook, Word, Excel).
• Ability to cope with ambiguous, changing environment while under pressure in a calm manner.
• 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 Functions:

• Obtains patient data from referring physician office for support of medical necessity; ensures data integrity.
• Verifies insurance utilizing both website and phone verifications.
• Completes the insurance verification form and ensures proper documentation is scanned into the patient medical record.
• Reviews payer medical policy to determine medical necessity based on payer guidelines and/or FDA indications.
• Utilizes insurance payers policies and requirements to determine coverage.
• Provides a comprehensive coverage and benefit summary, documentation, and on-going communication for updates, changes and authorizations.
• Manages an on-going case load of patients on long-term therapies, including reauthorization as applicable.
• Coordinates first payment and payment plans when necessary.
• Obtains signed written orders (SWO) and letters of medical necessity (LMN) when required.
• Demonstrates ability to maintain calm under pressure.
• Acts as a primary point of contact on-call for after-hours and holidays as needed.

About the Benefits:

• Competitive Compensation
• Comprehensive Medical Insurance
• Dental and Vision Insurance
• Company Life Insurance
• Voluntary Life and Disability Insurance
• Additional Voluntary Supplemental Plans
• Flexible Spending Account (Medical and Dependent Care)
• Health Savings Account
• 401K Retirement Plan
• Employee Assistance Program (EAP)
• Employee Discounts
• Ramsey SmartDollar Program
• Referral Program
• Tuition Assistance
• Paid Time Off
• 8 Paid Company Holidays

Patient Advocacy Statement:

At Palmetto Infusion, we believe that patient advocacy is at the heart of everything we do, regardless of our roles within the organization. Each member of our team is dedicated to putting the needs and well-being of our patients first. Whether we're working directly with patients or supporting them behind the scenes, our commitment to being a compassionate advocate is paramount. We understand that every interaction, every decision, and every effort contribute to the quality of care our patients receive.

Together, we strive to ensure that every individual feels heard, supported, and empowered throughout their healthcare journey. This dedication to patient-centered care is what creates "The Palmetto Experience" a standard of excellence that defines us and enriches the lives of those we serve.

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 25 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:

All employees must uphold the confidentiality of protected health information and follow all HIPAA policies. This position has access to sensitive information and a breach of information may be grounds for immediate termination.

We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.