AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD), Infusion Care and Ophthalmic solutions. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.

The Financial Services, Intake role is a full-time position responsible for Intake processes for TDD services that includes insurance eligibility and benefit review, authorizations and appeals, and denial management for services rendered.

EDUCATION AND EXPERIENCE:

• A high school diploma or general education degree (GED) equivalent is required.
• 3-5 years of healthcare industry experience strongly preferred.
• Home Infusion, Intrathecal Pain Management experience preferred.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Thorough knowledge of the processes for patient insurance eligibility and benefits for a variety of payers to include but not limit to: Aetna, Cigna, BCBS, Humana, Worker’s Comp, Medicare, and Medicaid.
• Specific knowledge of Authorization processes relative to GAPs, Pre-determinations, PCP Referrals, and Single Case Agreements.
• Detailed and accurate entry of insurance and authorization information into EHR systems per Standard Operation Procedures.
• Completes follow-up on pending or expired authorizations, referrals as assigned.
• Review authorization denials for accuracy; initiate the appeal process until the case is overturned, appeal options are exhausted, or decision is made to discontinue process
• Documents details of all calls per the Standard Operation Procedures of the department.
• Timely follow up and response to all Quality Reviews.
• Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality.

• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Maintains understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.
• Maintains a broad range of knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes.
• Shares knowledge gained with other staff members and works as a team member.
• Interacts with others in a positive, respectful, and considerate manner.
• Performs other job-related duties as assigned.

QUALIFICATION REQUIREMENTS:

• Understanding of Eligibility, Benefit, and Authorizations.
• Ability to recognize, evaluate and exercise good judgment in solving complex situations and advising in accordance with laws and regulations.
• Excellent verbal and written communication and relationship building skills with an ability to prioritize, negotiate, and work with a variety of internal and external stakeholders.
• Strong work ethic with personal qualities of integrity and credibility.
• Ability to deal with highly sensitive and confidential material, strong knowledge of HIPAA privacy guidelines and requirements.
• Knowledge of medical terminology.
• Ability to communicate effectively and professionally with patients, visitors, physicians, and coworkers.
• Self-directed, detail oriented, conscientious, organized, and able to follow through.
• Ability to deal in an organized manner with problems involving multiple variables within the scope of the position.
• Skill in establishing and maintaining effective working relationships with other employees, patients, organizations, and the public.
• Proficient in Microsoft Office, including Outlook, Word, and Excel.

Steps to Apply:

Complete the required Culture Index Candidate Assessment (Directions to follow below in this job posting, so please read in its entirety). *** No application will be considered if the applicant does not follow instructions and complete the assessment as part of the application process.

Culture Index Candidate Assessment

Why does AIS utilize the Culture Index Assessment?

• We recognize how important our employees are to the success of our company. Our company continues to thrive due to a culture of teamwork and our ability to match potential hires with positions that best utilize their natural traits and skillsets. AIS utilizes the Culture Index Candidate Assessment surveys to help us select the best match for our positions.

How can I complete the assessment?

• Copy and paste the following link into your browser and press enter. Then, select the corresponding position for which you are applying. (Only one assessment per candidate is required.) The assessment is brief, taking less than ten minutes to complete.

portal.cultureindex.com/public/survey/general/0BFB8F0000

• AIS HealthCare™ is the leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home intravenous infusion, including immune globulin therapies. These services, combines with your advanced nursing and care coordination solutions, assist physicians and hospitals in delivering a superior level of care for optimal therapeutic outcomes.

We offer a wonderful work culture, looking for an impact player who is positive, earnest and hardworking