Patient Referral Coordinator

BioMatrix Specialty Pharm•Syracuse, NY

45d•Hybrid

About The Position

The Patient Referral Coordinator is responsible for the processing and coordination of all new referrals with the main objective being to clear all patients prior to service in order to ensure proper payment in compliance within all legal and regulatory parameters. This person will ensure accurate, efficient and timely processing of new referrals for Infusion and Enteral services to include, but not be limited to, obtaining all necessary supporting documentation, confirming insurance coverage, coding and pricing of products, documenting patient in applicable computer system, submitting for pre-authorization and coordinating of initial “pushing” of the referral. The Admissions Representative provides support and works collaboratively with referral sources, hospital liaisons, the pharmacy, nursing, and billing and branch personnel.

Requirements

Associate’s degree in Business, Health Care Services, or Medical Sales required
Minimum of one (1) year of experience in healthcare industry required
Strong working knowledge of first- and third-party payer requirements as it pertains to the billing and collection industry
Excellent management, communication, interpersonal, team-orientation, organizational and analytical skills
Prioritization and multi-tasking skills
Proficiency with problem resolution
Self-motivated and self-disciplined
Computer aptitude
Mathematical aptitude

Nice To Haves

Minimum of two (2) years of experience with a home care company preferred
Prior home infusion experience on the provider or payer side preferred

Responsibilities

Provide knowledge and leadership regarding infusion intake processes by: Receiving new requests for services via phone, fax or other means
Obtaining all information necessary to accurately process the referral according to established procedures
Completing referral process within time frame required to meet the needs of the patient, family and referral source
Accurately completing the patient record in applicable computer system to include all required demographics, insurance and clinical information; recording appropriate progress notes and alerts to present a clear concise picture of patient data
Confirming insurance coverage for services requested; gathering detailed information regarding, but not limited to, eligibility, deductible, out of pocket, authorization requirements and patient obligations
Communicating with referral source or liaison regarding, but not limited to, insurance coverage, information limitations and status of referral
Obtaining insurance authorization when necessary; entering and documenting authorization according to established procedure; tracking authorizations due to expire and obtaining renewals as needed
Assuring accurate and complete billing information is obtained and recorded to allow for timely claim submission and payment, thus reducing accounts receivable days outstanding
Communicating any financial obligations to the patient or his/her designee; assuring their understanding and agreement to pay; establishing a payment method up-front, i.e. credit card
Maintaining the pending referral log on a daily basis; attending rounds each morning prepared to discuss status of each patient
Responding to requests for assistance from pharmacy billing and clinical personnel
Remaining familiar with specific payer guidelines, requirements and contracts
Staying current and implementing industry changes
Consulting with the Admissions Director or Admissions Manager when faced with unfamiliar situations and when decisions outside of the Intake Representative’s scope need to be made
Assisting with special projects and perform other duties at the discretion of the Admissions Director or Admissions Manager
Maintaining monthly Referral Census Log
Serving as a company resource with regards to Infusion processing and reimbursement
Demonstrating a professional, cooperative and friendly attitude toward all internal and external customers and co-workers; demonstrating excellent customer service skills
Using discretion in handling confidential matters
Adhere to departmental/company policies and procedures by: Adhering to policies and procedures
Adhering to regulations set forth by Medicare and Medicaid
Adhering to regulations set forth by insurance carriers
Adhering to regulations set forth in established company contracts
Exhibits exceptional work ethics by: Not being wasteful or abusing branch/company resources (vehicles, building, equipment, supplies, phone, utilities time at work, time absent from work, etc.)
Presenting fair and honest reports of expense
Following through timely on commitments
Returning phone calls and e-mails promptly
Being flexible and having the ability to prioritize
Allowing others to speak without interruption
Using proper grammar, a respectful tone and language free of prejudice, harassment, profanity or ill will connotations
Attempting to resolve