Insurance Case Manager
On-siteColumbia, South Carolina, United States
Columbia, South Carolina, United StatesOn-siteFull TimeHigh School Or EquivalentMedium
Full TimeHigh School Or EquivalentMedium
Job Summary
Accept new patient referrals, obtain necessary information from MD offices, and verify insurance benefits and coverage for infusion services. Review medical necessity by analyzing payor policies and FDA guidelines, then document clinical rationale in the EMR system to support approval or denial. Coordinate authorizations and predeterminations while maintaining accurate case management through scheduling. Communicate with peers and supervisors to ensure operational integrity and process improvement. Assist the sales team with education materials as requested.
Required Qualifications
- High school diploma or equivalent
- 1 year of healthcare experience or customer service experience
- 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
- 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
- All employees must uphold the confidentiality of protected health information and follow all HIPAA policies
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.