This position will support multiple outpatient ambulatory pharmacies and an RSV clinic setting. The expectation is the candidate acts as a primary authorization specialist, bills certain accounts in conjunction with third party billing company. Coordinates on RSV clinic days with patients and clinical staff. Helps support intake staff in different capacities and provides pharmacy billing related knowledge for clean claims output.
The core functions include but are not limited to:
Verifies eligibility with insurances, and documents findings in patient account. Patient paperwork showing responsibility and government required documents are prepared and given to patients timely.
Obtains authorization for patient care. Follows up daily on pending authorizations to assure claim drops for billing as soon as possible. Reports any delays in authorizations to Managers.
Works with clinical staff and management to make recommendations for contract negotiations with insurance companies and medical groups. Identifies areas for greater reimbursement.
Contacts patients' representatives, and effectively schedules patients and coordinates their insurance coverage. The Coordinator informs patients' representatives of their financial responsibility. The Coordinator refers clinical questions to the appropriate clinical resources.
Processes insurance claims completely, meeting all contractual requirements for timeliness.
Regularly educates RSV clinic staff and billing and collections staff on changes in insurance plans, contracts, insurance company billing policies and other procedures related to the RSV clinic to insure the optimum financial performance of the clinic.