Customer Service Coordinator- PAP Resupply

Advocate Health and Hospitals Corporation•Milwaukee, WI

1d•Remote

About The Position

The Customer Service Coordinator - PAP Resupply role is a full-time position within the RT/HME - Patient Access department. This role is an at-home position, working Monday through Friday from 8:00 AM to 5:00 PM. The primary function is to ensure a smooth and timely transition for patients from hospital to home, providing support and optimizing insurance benefits. The coordinator acts as a liaison, explaining processes and benefits, verifying insurance, obtaining prior authorizations, and resolving any documentation or medical management gaps. They coordinate with distribution operations and patients for timely service provision and deliver quality customer service to all stakeholders. This role requires proficiency in computerized systems, data entry, and monitoring insurance verification reports. The coordinator also assesses patient financial responsibility, negotiates payment plans, and participates in performance improvement initiatives. Continuous updating of knowledge regarding Medicare, Medicaid, HMO, and managed care requirements is essential.

Requirements

High School Graduate.
Typically requires 5 years of experience in medical entry, claims processing, HME business line, home care, insurance verification, home care customer service or other healthcare related position.
Knowledge of HME/RT equipment.
Understanding of third party payors, including Medicare, Medicaid and private insurance companies.
Regularly interfaces with representatives of third party payers.
Wide range of contacts with hospitals, long term care facilities, rehab and therapy facilities, physician’s offices, case managers, utilization review managers, patients and their families.
Communication is both verbal and written.
Determine acceptance of patient with low financial risk, high risk cases and appropriately search out the resources.
Prioritization of insurance verification and prior authorization to ensure department goals and objectives are obtained.
Monitor all managed care patients' supply orders and re-orders to insure that adequate and current authorization is in the data base so as to enhance quick reimbursement.
Troubleshoot equipment problems appropriately seek out further assistance if needed.
Handle confidential information on every client.
Function under tight time constraints to verify insurance benefits before delivery of equipment, of data entry of referral information necessary for delivery ticket with proper qualifying diagnoses for each piece of ordered equipment.
Heavy volume of daily incoming and outgoing phone calls and documents must be processed timely and accurately.
Very fast paced.
Strong data entry and phone skills.

Nice To Haves

None explicitly mentioned, but knowledge of HME/RT equipment and understanding of third-party payors are listed under requirements, implying they are crucial.

Responsibilities

Evaluates HME referral and service order requests to ensure smooth and timely transition for patient from hospital to home while ensuring the patient is supported safely and insurance benefits are optimized.
Advocates for patient serving as a liaison to explain prescription order, hospital transition and home start of care process, and insurance benefits.
Access service requests in relation to organization acceptance criteria and evaluates medical documentation to ensure payer coverage criteria are satisfied.
Verifies patient insurance benefits and eligibility and contacts insurance plan to obtain service prior authorization as needs and determines patient co-insurance.
Provides direction to physicians on how to resolve documentation or medical management gaps when documentation does not support medical necessity or payer coverage criteria.
Identifies risk issues and collaborates with patient, physician, hospital staff and other care providers to ensures resolution and patient safety.
Coordinates timely provision of service with distribution operations and the patient.
Provides quality customer service for all customers, including patients, physicians, referral sources, and coworkers within Advocate Aurora Healthcare and external customers.
Responds courteously and professionally to client requests and concerns and follows through to appropriate resolution.
Ensures current, correct authorizations for all managed care clients to meet client needs and assist other Advocate Aurora departments.
Adheres to established processes for quality customer service, such as Electronic referrals, HME coding, Pickups and faxing.
Takes on additional responsibilities to assist in resolution of customer concerns and other business needs.
Is proficient in the use of computerized resources and data entry programs involving proper processing and qualifying of patients with HME business line needs.
Monitors and works all necessary insurance verification reports for assigned products lines and assigned payors.
Runs, collects and tabulates data and submits to management selected and assigned reports.
Identifies, investigates and verifies sources of reimbursement and makes recommendations based on the information obtained.
Obtains and documents payor eligibility information for each new referral, addition to service and re-admission and determines if payor's coverage requirements are met for services or equipment.
Assesses potential third-party liability cases to determine who is the primary payor and relays the appropriate billing requirements to the patients accounts staff and operations.
Checks with referral sources for any intermittent services that might be need by the patient and suggests companion items for the equipment ordered to better service our patient.
Provides pricing information to explain the financial responsibility to patients.
Assesses the patients ability to pay and negotiates payment plans and determines their financial risk at the time of referral.
Recommends appropriate action and notifies patient and/or family of the expected financial responsibility at the start of care.
Participates in performance improvement and patient satisfaction initiatives.
Serves as a member of department division or system performance or process improvement group as appropriate.
Works with management to implement change and identify opportunities for improvement.
Continuously updates knowledge of Medicare, Medicaid, HMO and managed care of the complex and ever evolving coverage requirements and guidelines.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program