We are seeking a highly motivated and detail-oriented Intake Manager to lead and manage our insurance verification and authorization processes, specializing in infusion and pain management services for AIS Healthcare’s Targeted Drug Delivery (TDD) services. This role will oversee the daily operations of the insurance verification and authorization team, ensuring compliance with insurance requirements, maximizing reimbursement, and improving overall revenue cycle efficiency.
The ideal candidate will have in-depth knowledge of insurance verification, prior authorization processes, medical coding, and healthcare billing practices, with a strong background in infusion and pain management. The individual will also have proven leadership experience in managing a team through process changes and be able to collaborate effectively with peers to drive operational improvements.
Education And Experience
A high school diploma or general education degree (GED) equivalent is required; bachelor’s degree preferred.
5-7 years of healthcare industry experience with 3-5 years Verification & Authorization Management & Leadership experience required.
Home Infusion, Pain Management experience preferred.
Proven leadership experience managing and transitioning teams through process changes.
Essential Duties And Responsibilities
Lead, train, and manage a large team, ensuring all team members are equipped to handle insurance verification and authorization tasks efficiently.
Successfully guide the team through process transitions, providing support and clear communication during change management initiatives.
Set performance goals, monitor team progress, and conduct regular performance reviews.
Foster a collaborative, positive, and efficient work environment within the team, promoting teamwork and open communication.
Oversee the verification of patient insurance eligibility, benefits, and coverage, specifically related to infusion and pain management treatments.
Ensure timely and accurate submission of prior authorization requests, ensuring that all documentation and medical necessity criteria for infusion and pain management services are met.
Maintain and update records of all authorizations and verifications to ensure accuracy and compliance with payer requirements.
Ensure compliance with payer requirements, federal and state regulations, and internal policies, specifically focusing on infusion and pain management services.
Stay up-to-date with changes in insurance guidelines, infusion therapy requirements, pain management protocols, and healthcare regulations.
Ensure adherence to payer-specific rules regarding pre-certifications, medical necessity, and eligibility criteria for infusion and pain management services.
Collaborate with the billing team to resolve discrepancies between verification/authorization and billing, with a focus on infusion and pain management services.
Ensure timely and accurate completion of the verification process to avoid claim denials.
Proactively address issues that may lead to claim denials or delays in reimbursement for infusion and pain management treatments
Prepare and analyze reports related to insurance verification and authorization activities, with an emphasis on infusion and pain management services.
Work with senior management to implement strategies that increase operational efficiency and improve financial outcomes, particularly for infusion and pain management services.
Serve as the primary point of contact for internal departments and external insurance companies regarding verification and authorization issues, particularly for infusion and pain management services.
Provide excellent customer service to patients, providers, and insurance representatives.
Educate patients on their insurance benefits and authorization requirements, especially regarding infusion and pain management treatments.
Continuously evaluate the effectiveness of existing processes related to infusion and pain management services and make recommendations for improvements.
Implement best practices and new technologies to improve workflow efficiency and accuracy for insurance verification and prior authorizations.
Collaborate with peers and other departments, including clinical teams, to ensure smooth transitions during process changes and optimize the overall revenue cycle process, with a focus on specialized services.
Performs quality reviews on current procedures to monitor and improve efficiency of intake operations.
Analyzes trends impacting revenue and takes appropriate action to realign staff and revise policies and procedures.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Maintains a thorough understanding of NDC (National Drug Code) numbers, metric quantities, and knowledge of infusion supplies.
Completes hiring, scheduling of staff, time, and attendance review.
Performs other job related duties as assigned.
Qualification Requirements
Understanding of all Revenue Cycle Management functions and integration of one another.
Prior experience working with high-complexity cases, including infusion therapy and pain management.
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.
Self-directed, detail oriented, conscientious, organized, and able to follow through.
Proficient in Microsoft Office, including Outlook, Word, and Excel.
Travel up to 25%.
Steps To Apply
To apply for this role, you must complete a Culture Index Assessment to be considered. Please note that your application will not be considered if the Assessment is not completed.
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.
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
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Health Care Provider
Industries
Pharmaceutical Manufacturing
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