Home Infusion Intake Specialist

Texas Health Resources•Fort Worth, TX

4d•Onsite

About The Position

Bring your passion to Texas Health so we are Better + Together. This role involves managing the intake process for home infusion therapy, including receiving referrals, verifying patient benefits, coordinating authorizations, adjudicating orders, investigating financial benefits, arranging home health nursing visits, managing work queues in EPIC, and providing customer service. The specialist will serve as a liaison to promote transparency and trust, and ensure accurate documentation in the patient's clinical record.

Requirements

High School Diploma or Equivalent Required
2 Years Insurance verification, benefits, and eligibility investigations required
1 Year Experience in specialty, home infusion or hospital pharmacy preferred

Nice To Haves

Associate’s Degree Business / Communication Preferred

Responsibilities

Receipt of Referral: Receive referrals through EPIC or fax, triage, and route them to the correct work queue. Determine if a referral needs clinical review and route accordingly.
Verification of patient benefits and submission for authorization when required: Verify patient benefits via payor portal, ascertain deductibles and co-pays, and complete prior authorizations.
Adjudication of order: Adjudicate medication orders based on NDC number, in conjunction with a pharmacist, considering reimbursement rates.
Financial benefits investigation and counseling: Conduct full benefits investigations for insured patients to outline their financial responsibility. Perform financial reviews for uninsured patients and generate FPI numbers. Track patients qualifying for charity and bill discharging facilities separately. Mark non-qualifying patients as Self-Pay and provide financial agreements.
Contacting and finalizing home health nursing visits: Contact home health agencies and set up visits based on patient location, therapy type, and insurance benefits.
Managing the assigned work queues in EPIC: Monitor work queues, complete required tasks in a timely manner to advance referrals through the process.
Hand-off of referral to pharmacist: Move the referral to the pharmacist work queue once all intake tasks are completed.
Customer Service and Escalation: Address patient and customer service inquiries empathetically and professionally. Escalate unresolved issues related to insurance, finances, or clinical matters to the appropriate leader or team. Serve as a liaison to promote transparency and trust. Document all requests and conversations in the patient's clinical record.
Documentation Standards: Accurately document referral information, insurance benefits, authorization status, and patient communication notes in EPIC and other systems. Maintain clear, timely, and compliant documentation.