Job Description:

Busy Specialist Medical Office and Infusion Center looking for F/T Experienced Authorization Coordinator for Infusion Medications and Prescription Medications. This role will work closely with referring providers as well as providers within our practice.

Will acquire benefits online and call insurance payers to obtain coverage for Infusion services and Prescription Medication in details. Will add insurance info and coverage obtained in patient's account in the various systems. Provide excellent customer service. Share in daily telephone calls from patients regarding financial questions, copay assistance enrollment or authorization process. Direct manager supervision regarding any concerns or problems. Provide assistance to the Billing department as needed.

The candidate must have a working knowledge of medication guidelines for infusions with understanding of insurance policies, medical as well as prescription benefits

This position requires gathering information for authorization appeals or peer to peer calls between MD’s and insurance company reviewer

Responsibilities

· Determining insurance eligibility, benefit verification and authorization requirements

· Conduct chart reviews to ensure clinical documentation meets medical necessity and medical criteria requirement

· Obtain medical records from outside referring provider / Contacting outside referral source for any clarifications needed

· Ensure that authorization match the authorization obtained. Understanding ICD 10 and CPT Codes

· Communicate effectively, both written and verbal. Able to communicate referral/authorization information and pertinent medical information to the nursing staff as well as to patients. Counseling patients regarding the medications or services. Act as a liaison between patients, clinic/providers, specialty care providers health plans/funding sources, and community resources.

· Coordinates financial arrangements, collects payments, and applies payments.

· Prepares minimal financial reports to supervisor monthly

· File appeals for denied cases and follow through on that process

· Timely, organized documentation. Record keeping and Notes must be accurate and thorough.

· Demonstrate the ability to act as a team player in a professional and positive manner

· Experience working with in-network and out-of-network benefits

· Schedule Initial Infusion appointments

· Proficient in basic math/Proficient in Microsoft Excel, Word, and Outlook