- Responsible for reaching out to patient's insurance company for health insurance eligibility, benefits coverage / non coverage information, medical necessity and extension of authorization
- Updating demographic, physician, insurance, and other information into patient's profile.
- Review all incoming orders and clinical documentation for accuracy.
- Obtain clinical documentation as needed.
- Conduct comprehensive benefit investigation for new patient orders
- Evaluate medical and pharmacy benefits.
- Initiate, follow up and secure prior authorization, pre determination or medical review.
- Regularly collaborate with oncology leaders and pharmacy, to identify opportunities for drug substitutions on an as needed basis.
- Communicate denials to physician's office and provide detail on peer to peer appeal options.
- Regularly communicate status of intake process to nursing, pharmacy and oncology.
- Responsible for adhering to quality, production and standards associated with department.
- Suggest and develop documentation to standardized process changes and submit for approval.
- Notify and educate patient/referral sources regarding coverage and financial payment responsibilities.
- Collaborate with financial advocate for self and under insured patients.
- Other duties as assigned
- High school diploma or equivalent
- At least 3 year experience working in practice environment or commercial insurance required as well as In depth experience with referrals, benefit verification and authorization request
- Ability to multi task and support numerous incoming tasks while ensuring accuracy.
- Working knowledge of Medicare, Medicaid and managed care reimbursement guidelines
- Ability to communicate effectively and professionally with patients, physicians and co workers
- Certified Hematology and Oncology Coder
- Specialty pharmacy/ PBM experience preferred
- Medical Oncology/ Infusion office experience
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intake infusion coordinator - Wakefield, South Kingstown, RI , USA, United States - South County Hospital
Description
Full Time70 Kenyon Avenue
Unassigned
day
Infusion Intake Specialist is a full time position that is responsible for providing patient access to infusion therapy as needed.
This role will serve as a primary liaison for all incoming infusion orders for accuracy and appropriateness of medical necessity.
This role will include analyzing data to ensure appropriate scheduling of infusions and collaborated with leaders of oncology and pharmacy.
Job Summary
