Diagnostic & Authorization Advocate

Eye Care Partners Career•Grand Rapids, MI

8d•Onsite

About The Position

EyeCare Partners is the nation’s leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit www.eyecare-partners.com . Company: Grand Rapids Ophthalmology Job Title: Diagnostic Advocate Department: Ophthalmology Reports To: Clinic Supervisor Location: This position is located in Grand Rapids, MI SUMMARY The ideal candidate will have strong communication and computer skills, and as well as strong organization and attention to detail, to provide a positive impression, showing patients we provide unsurpassed care right from the start.

Requirements

High school diploma or general education degree (GED) required
Previous medical office experience preferred; previous ophthalmic experience strongly preferred.
Professional in appearance and actions
Logical and Critical thinking skills
Customer-focused with excellent written, listening and verbal communication skills
Enjoys learning new technologies and systems
Detail oriented, professional attitude, reliable
Exhibits a positive attitude and is flexible in accepting work assignments and priorities
Meets attendance and tardiness expectations
Management and organizational skills to support the leadership of this function
Ability to follow or provide verbal & written instructions with sufficient grammar and spelling skills to avoid mistakes or misinterpretations
Interpersonal skills to support customer service, functional, and team mate support need
Able to communicate effectively in English, both verbally and in writing
Ability for basic to intermediate problem solving, including mathematics
Basic to intermediate computer operation
Proficiency with Microsoft Excel, Word, and Outlook
Access to dependable transportation
Driving record must meet company liability carrier standards
Specialty knowledge of systems relating to job function
Knowledge of state and federal regulations for this position; general understanding of HIPAA guidelines

Nice To Haves

Travel to other site locations may be necessary.

Responsibilities

Prior Authorizations
Assistance with Self-pay processes
Good Faith Estimates
Patient Drug Assistance Applications
Back up template management/reschedules for doctors
Keep track of all lab orders, lab results, file results to EMR's notify providers of new results as they are reported and scanned to the chart.
Keep track of all radiology orders.
Ensure the ordered imaging complies with both National Radiology Guideline and Insurance Clinical Guidelines.
Ensure all necessary information is included on each imaging order, ICD-10 codes are specific/descriptive for the clinical tests results related to imaging that is ordered.
Work with insurance prior-authorization portals and/or prior-authorization representatives and nurse reviewers to successfully obtain all necessary insurance prior authorizations prior to sending the imaging orders to radiology central scheduling.
Update the Nextgen lab order module as needed to stay current with the hospital laboratory's compendium.
Update the Nextgen radiology module with new test as requested by providers.
Connect patients in need of assistance in affording their eye drops, to an available assistance or discount program, if possible. Provide them with necessary information and the initial application for that program.
Mail out renewal applications annually for as long as they remain on the drop.
Complete provider portion of application and have the provider sign the application.
Submit all information necessary patient and provider paperwork to the assistance program, to give the patient the best chance of qualifying for the program.
Keeping the providers informed when new drugs become available or is removed from an assistance program.
Research affordable alternative discount programs for patients not eligible for an assistance program or for whom their medication has been removed from an assistance program.
Ensure all drops that are required to be shipped to the primary clinic location, are received and sent to the patient's preferred pick-up location and patient notified that their drops are available for pick up at that 2 location.
If patients’ circumstances prevent them being able to pick up their drops at a clinic location, mailing the drops is permitted.
Keep detailed records on all patient assistance participants, the program, or programs they are on and when their application must be renewed.
Keep a record of whose drops are shipped directly to the patient and which drops are shipped the practice.
Make note of patients who are to call for their own refills and which patients need their drops ordered by the practice.
Performs other duties that may be necessary or in the best interest of the organization.