This position will support multiple outpatient ambulatory pharmacies and clinic settings. 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.
To improve the patient experience by providing health care providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.