Insurance Coordinator - Orange, United States - AmeriPharma

AmeriPharma

Verified Company

Orange, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients.

It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that
We Care

AmeriPharma is a rapidly growing company where you will have the opportunity to contribute to our joint success on a daily basis.

We value new ideas, creativity, and productivity.

We like people who are passionate about their roles and people who like to grow and change as the company evolves.

At AmeriPharma, you'll have access to:

Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
Great pay and general compensation structures
Employee assistance program to assist with mental health, legal questions, financial counseling etc.
Comprehensive PTO and sick leave options
401k program
Plenty of opportunities for growth and advancement
Company sponsored outings and teambuilding events
Casual Fridays

Job Summary

As an Insurance Coordinator at AmeriPharma, you will be responsible for accurate and timely verifications of patients' medical insurance coverage and securing medical prior authorization to allow for appropriate and prompt payment of services.

Duties and Responsibilities

Screens and prioritizes orders that require benefits investigation and medical prior authorization
Reviews completeness of payers documented in each patient's insurance profile
Identifies patient's primary, secondary, tertiary, or supplemental plans and authorizing group
Reviews accuracy of insurance set up, plan and payer categories
Calls insurances to verify specific details on insurance plan coverage and meticulously documents the

following information; Date of verification, name of insurance, plan type, plan effective date, covered
procedure codes, deductibles, plan coverage, current level of coverage, maximum out-of-pocket
spending, plan exclusions and limitations, coverage based on place of service, authorization
requirement, claims billing address, claims risk, third party processors, in/out of network coverage and
other applicable billing details

Documents all communications with insurance plans including the name of insurance representative,

telephone, and call reference number

Identifies and communicates with patients, prescribers and team members plan exclusions and

restrictions, inadequate reimbursement rates and non-covered services

Executes necessary and applicable financial documents such as the Financial Obligation Notification

and Medicare Advance Beneficiary Notification (ABN) and takes an active role in helping patients
obtain and understand their medical benefits

Identifies and informs providers and patients of network providers and Ameripharma's network

participation status

Records all financial discussions with patients and prescribers in patient's file
Identifies, facilitates and coordinates patients' enrollment to medical drug copay programs
Coordinates review of orders or cases that require clinical judgment with a clinical staff
Submits prior authorization request to medical plans
Informs providers of medical authorization status and payer decision on their requests per department

procedure

Obtains and communicates directly with providers any necessary clinical information or medical

records needed to appeal a denied or pending authorization request

Answers medical authorization inbound calls from patients, providers, and other departments
Identifies changes in patient's medical plan coverage and coordinates/reviews new plan payer

information with Billers ensuring continuation of service and adequate reimbursement coverage and
update payer assigned to orders accordingly to ensure accurate and proper medical claim submission

Assists with the resolution of escalated member or provider inquiries related to medical prior

authorization and benefits coverage
investigations and medical prior authorization requirements and processes

Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or

pending activities

Generates reports to keep track of ongoing patients' monthly eligibility verifications
Generates reports to keep track of Expiring Medical Authorizations and initiates submission of

reauthorization requests ensuring continuity of patient's drug therapy without any delays

Documents detailed medical authorization status on each patient's account (new or otherwise)

accurately and in a timely manner

Escalates to management any unresolved benefits investigation and medical prior authorization issues

after proper resolution attempts have been made

Maintains a full caseload while meeting or exceeding designated metrics and turnaround timeframes
Runs pharmacy test claims to determine current level of patient's prescription plan coverage as

needed