Home Infusion Intake Specialist

Texas Health Resources•Fort Worth, TX

2h•Onsite

About The Position

This position will be responsible for receiving and processing new referrals for home infusion services. These duties will include benefits verification, financial payment planning, co-pay and deductible calculations, receiving patient payments, troubleshooting claim rejections, obtaining prior authorizations and supporting both Professional Billing and Pharmacy staff in their duties.

Requirements

High School Diploma or Equivalent Required
2 Years Insurance verification, benefits, and eligibility investigations required

Nice To Haves

Associate’s Degree Business / Communication Preferred
1 Year Experience in specialty, home infusion or hospital pharmacy preferred

Responsibilities

Receipt of Referral: Referrals may be received through the Outpatient Referral pathway in EPIC or via fax from a non-THR provider. Referrals will be triaged and routed to the correct work queue in EPIC for further work-up. If a referral needs to be reviewed by a clinician, the intake personnel will make that determination and route the referral to the appropriate person.
Verification of patient benefits and submission for authorization when required: Intake staff will verify patient benefits by accessing payor portal. Status of deductibles and any co-pays will be ascertained and added to the financial worksheet. Any prior authorization will be completed at this step.
Adjudication of order: Medication orders will be adjudicated based on the NDC number of the product. NDCs are reimbursed at different rates. The final determination of which NDC to use will be based on the adjudication results and in conjunction with a pharmacist.
Financial benefits investigation and counseling: Insured patients will go through a full benefits investigation with the goal being to produce a financial statement for the patient that outlines their total financial responsibility. Uninsured patients will have a financial review with an FPI number being generated from this review. Patients that qualify for charity will be tracked and the discharging facility will be billed separately. Patients that do not qualify for charity will be marked as Self-Pay and a financial agreement will be provided to the patient and must be signed prior to accepting them for service.
Contacting and finalizing home health nursing visits: Based on patient location, therapy type, and insurance benefits, home health agencies will be contacted, and home health visits will be set up for the durations of the patients therapy.
Managing the assigned work queues in EPIC: Referrals will move into various work queues as tasks are completed. These work queues must be monitored and the required tasks completed in a timely manner in order to move the referral forward through the process.
Hand-off of referral to pharmacist: Once all intake tasks have been completed the referral will be moved to the pharmacist work queue.
Customer Service and Escalation: Patient and Customer Service Support. Address questions and concerns from patients, caregivers, and referral sources in a timely, empathetic, and professional manner. Escalate unresolved or complex patient issues which include complaints related to insurance coverage, financial responsibility, or clinical matters and route these patient issues to the appropriate leader or team. Serve as a liaison to promote transparency, reduce stress for the patient, and enhance trust throughout the intake process. Document in the patient's clinical record progress notes, all requests and conversations for the purposes of seamless coordination of care.
Documentation Standards: Documentation and Systems Use. Accurately document referral information, insurance benefits, authorization status, and patient communication notes in EPIC and all applicable systems. Maintain clear, timely, and compliant documentation to support care coordination and revenue cycle processes.