Intake Reimbursement Specialist

Fairview Health Services•Shoreview, MN

12d

About The Position

As a member of the Business Office, the Reimbursement Specialist uses strong customer service skills and knowledge of authorization and reimbursement practices to ensure patients fast, easy and appropriate access to pharmacy services. The Reimbursement Specialist accepts and processes referrals, identifies payer sources, verifies benefit information and acquires initial authorization as needed to begin patient service or to determine denial of patient service. This position also follows up on pending unresolved coverage issues and claim denials and documents and communicates to appropriate providers and internal department's accurate authorization information on current or potential patients. This role will provide services for management of Fairview Homes Infusion as well as external customers. This includes consulting and training services for external consulting engagements. Using strong knowledge of insurance, pharmacy practice, revenue cycle and in accordance with department Standard Operating Procedures (SOPs) and any regulatory or compliance requirements. Perform verification of insurance benefits, analysis and identify any potential coverage issues. Assure fast, easy access to pharmacy services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process. Assist in resolving problems with payers and provide information and expertise to other departments. Partner with potential international and self-pay patients on any financial or service needs related to their care as assigned. Serve as a resource to the affiliations, staff and physicians regarding Fairview’s pharmacy services in assigned area. Assist with the coordination of services by communicating effectively and in a timely manner with others. Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training. Performs other duties as assigned. Complies with all policies and standards.

Requirements

2 years Experience in a pharmacy setting or with revenue cycle, health insurance or benefit experience using an enterprise software system in healthcare or insurance organization.
Revenue Cycle Certification or 3 years of related revenue cycle experience (e.g. - intake, registration, and authorization).

Nice To Haves

Bachelor of Arts In business, communications, health care or related field.
2 years of revenue cycle, health insurance or benefits experience using an enterprise software system in the assigned clinical area or service line of a complex healthcare organization.
Knowledge of ICD9 and ICD10 coding.

Responsibilities

Accepts and processes referrals.
Identifies payer sources.
Verifies benefit information.
Acquires initial authorization as needed to begin patient service or to determine denial of patient service.
Follows up on pending unresolved coverage issues and claim denials.
Documents and communicates to appropriate providers and internal department's accurate authorization information on current or potential patients.
Provides services for management of Fairview Homes Infusion as well as external customers, including consulting and training services for external consulting engagements.
Performs verification of insurance benefits, analysis and identify any potential coverage issues.
Assures fast, easy access to pharmacy services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process.
Assists in resolving problems with payers and provide information and expertise to other departments.
Partners with potential international and self-pay patients on any financial or service needs related to their care as assigned.
Serves as a resource to the affiliations, staff and physicians regarding Fairview’s pharmacy services in assigned area.
Assists with the coordination of services by communicating effectively and in a timely manner with others.
Maintains current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
Performs other duties as assigned.
Complies with all policies and standards.