Infusion Insurance Specialist

VIVO Infusion - Infusion Insurance Specialist (Patient Access Specialist) Hybrid/Remote Compensation Pay Range: $24.00 - $26.00/HourBonus Plan Target: 5% Annually (Based on performance)Private Equity for the Greater Good - Company-wide Employee Ownership Program Benefits Medical, Dental, VisionHSA w/ Employer ContributionTouchcare - Insurance Concierge Service401K with Match up to 4%PTO: Accrual 3+ weeksPTO Buy-back, PTO Rollover, and PTO Donation Program.Wellness Reimbursement Program - $360 AnnuallyEmployee Referral Bonus - Uncapped Bonus PotentialTuition Assistance Program & Professional Association ReimbursementEmployee Assistance Program (Employer-provided)Short & long-term disability (Employer-provided)Life Insurance (Employer-provided) Employment Type, Schedule, FLSA Status Full-timePosition Schedule:Monday-Friday | Flexible hours 7:00am - 7:00pm ESTNon-Exempt Reports to: Patient Access Director Location: The Patient Access Specialist will work remotely from a home office with a secure network. Only candidates residing in the states below at the time of employment will be able to be considered. Travel with Vivo equipment is not permitted without prior approval. Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Wisconsin, Wyoming, Washington D.C. As the Infusion Insurance Specialist, known internally as a Patient Access Specialist, you will play a crucial role in supporting the Intake Process. You will collaborate with the Revenue Operations Lead and Manager to ensure thorough processing of referrals and patient scheduling. In this position you will also provide excellent customer service, gathering insurance authorizations and eligibility verifications. The individual is responsible for prioritizing, organizing, and completing assigned responsibilities and tasks in a timely manner. For This Position, Applicants Must Have The Following Experience 2 years of experience working in high-volume insurance verification, benefits, and eligibility/authorizations.2 years of medical billing and authorizations or managing physician referrals.1 year experience working in a customer service or patient facing role. Primary role responsibilities: Insurance Verification & Benefits and AuthorizationsVerify insurance eligibility and benefits for new and existing patients receiving infusion therapy and injectable medications, utilizing payer web portals (e.g., Availity, UHC Provider Portal) and direct payer contact as neededCoordinate benefits (COB) across primary, secondary, and tertiary payersMaintain working knowledge of all insurance contracts for assigned clinics and regionsUpdate patient accounts with current insurance information and ensure records remain accurate and currentSubmit prior authorization requests (medical benefits) for infusion therapy via phone, fax, and payer web portals, and follow up to ensure timely determinationMaintain authorization renewals for existing patients to ensure continuity of careManage initial insurance denials and appeals specific to infusion therapy, including drafting clinical justification and coordinating with provider offices for supporting documentationApply working knowledge of applicable CPT, HCPCS, and ICD-10 codes to authorization submissionsReferral & Documentation ManagementSubmit and follow up on PCP referral requests to ensure timely processing and continuity of careReview, identify, and compile medical records required for benefits verification and authorizationManage incoming eFax and email correspondenceEnsure referral packets and supporting documentation are scanned and stored in the appropriate EMR locationDocument referral progress and account updates in the referral tracking platformReview and process order updates as they are receivedPerform data entry and participate in accuracy auditsExisting Patient OperationsReview daily and weekly schedules for insurance eligibility, active authorizations, and current annual financial documentsIdentify and resolve issues that could disrupt continuity of care, such as expired authorizations, inactive insurance, or outdated documentationCommunication & CollaborationDemonstrate strong written and verbal communication when interacting with payers, referring office staff, patients, physicians, and internal teams, representing Vivo professionally in every interactionCoordinate with Clinical Operations and any necessary Patient Services teams — including Patient Care, Medical Policy, Patient Resources, and Specialty Pharmacy coordinators — on referral documentation, COB concerns, patient financial documents, authorizations, and renewalsUse approved templates, naming conventions, formats, and distribution lists for all system notations and email or task communicationPerformanceMeet departmental productivity, quality, and turnaround time standards as established by Patient Services leadership Secondary Duties And Responsibilities Assist with departmental projects as assigned, including account audits, system updates, data entry and reconciliation, acquisition support, and the annual reverification projectMaintain working knowledge of the referral tracking platform and the core EMRMaintain patient records and confidentiality via the electronic medical record system in accordance with HIPAA guidelines and all applicable Vivo policiesAttend all required meetings related to organizational, departmental, team, and individual performancePerform other duties as assigned Qualifications: Education:High school graduate or equivalent; associate or bachelor’s degree preferred.Experience:Experience with major medical health insurance benefits verification, prior authorization, and appeals for buy-and-bill infusion therapy and injectable medications strongly preferred.Minimum 2-3 years of related prior work experience required, preferably in the healthcare industry.Proven competencies can take precedence over prior work experience.Knowledge of Medicare & commercial/private insurance benefits, medical authorizations, HIPAA, and medical abbreviations and terminology preferred.Prior experience working with sensitive information and maintaining confidentiality.Skills:Proficient (intermediate level of application) with all Microsoft Office Products programs.Must possess outstanding communication and interpersonal skills, be able to communicate professionally and effectively with other staff members, patients, vendors, and physicians, and is fluent in written and spoken English.Experience supporting multiple managers/supervisors. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Who We Are The Vivo Infusion team is focused on providing patients with the highest quality of care in a comfortable, safe, and convenient setting! Vivo is a national company with locations in 15 states, providing opportunities for growth and advancement as well as competitive benefits that support what matters most to you. Our highly trained medical professionals are dedicated to delivering a safe, comfortable, and affordable solution for our patients. We offer an array of advanced therapeutics and provide personalized, care for every patient. These treatments are delivered by a highly-skilled, clinical nursing staff and monitored by board-certified advanced practitioners. Vivo Infusion has received The Gold Seal of Approval® from The Joint Commission. The Joint Commission Gold Seal of Approval is a nationally recognized distinction voluntarily earned by a select set of healthcare providers. An organization that achieves The Gold Seal of Approval® shows its commitment to holding itself accountable to a high bar for quality and safety for those they serve. Learn more about Vivo, by visiting our website: https://vivoinfusion.com/ Work Environment & Physical Demands The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. The employee is frequently required to sit for long periods. While performing the duties of this job, the employee is required to sit, talk, type, and hear. Requires excellent visual dexterity and manual dexterity. RECRUITMENT PRIVACY STATEMENT | Notice to All Applicants: Vivo Infusion posts all open positions on the Careers page of the company website: https://vivoinfusion.com/careers/ Applicants will never be asked to provide personal identification information (e.g., SSN, Driver’s License, Passport) or financial information (e.g., Banking Information) during the application and Interviewing process. We May Request Contact details such as name, address, email address, and phone number.Employment history including previous employers and job titles/positions.Background information including academic/professional qualifications, job qualifications, education, certifications or licenses, details included in your CV/resume, transcripts, and employment references.Nominated references including their name, contact details, employer, and job role.Proof of your eligibility to work in the US.Desired salary. If you have any questions or concerns about this Recruitment Privacy Statement or how we handle your personal data, please contact us at 855.478.1528 or emailing Info@VivoInfusion.com.