Specialty Products Patient Care Coordinator

Pentec Health

17h•$22 - $24

About The Position

Under the direct management of a Supervisor/Manager, this position is accountable for the intake functions & ongoing maintenance of Pentec Health, Inc’s patients. The primary goal for the position is to ensure the timely, seamless handling of our patient referrals and the accurate qualification of patient benefits and insurance carrier criteria. This is inclusive of referral source communications to ensure complete medical information is obtained, direct payor communications to determine coverage and secure necessary authorizations, and direct patient communications to relay benefit coverage and financial liability. Essential Job Duties: This position is accountable for the coordination of electronic documents related to nutritional support lines of business. The role requires thetimelyhandling,entryand distribution of these documents. This is inclusive offollow throughon referrals, authorization,auditsand the like. A thorough understanding of EMR, intake requirements,billingand authorization practices is necessary. They must be excellent internal teammates,trackersand communicators. Communicate well with internal and external customersin order toefficiently and effectively bring a patientfrom referral through start of care, and to support ongoing service. Maintainsaccuraterecords and keeps currentProgress Notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts. Gather and document a detailed and comprehensive understanding of the various insurance plans and benefits for the different payor classes (State Medicaid, Commercialinsuranceand Medicare plans) and being able to effectively communicate the therapy and coverage requirements to the Referral source, Patient and Payor sources.Extensive background working directly with payers to efficiently obtain authorizations to include gap/network exceptions. Apply prior and current knowledge of insurance carrier requirements and authorization practices to capture and communicateappropriate clinicaland financial datarequiredto obtain approval/authorization of service, professionally documenting the detailedoutcome of this process in EMR Possess professional telecommunication skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrierrepresentativesand internal teamsin order tofacilitathe referral process and obtain complete informationrequiredtoinitiatea patient's start of care. Receive and process requests for ongoing patient maintenance including RX changes& patientstatus changes. Completing reverifications and obtaining new authorizations asrequired. Serve as a point of contact for patient/ referral source concerns & performing shipment tracking. Accurately enter and update patient orders in the EMR. Ensure all line items are under theappropriate ordersfor correct billing. Review "Ready to Bill" forintakecodes.Identifythe reason for thehold, andwork to resolveissue. Communicate withbillingdepartment once resolution is achieved. Review patents on "hold" status underintakecodes.Identifythe reason for thehold, andwork to resolveissueto allow services to resume.Perform yearly reverifications for active patients, update information inEMRand obtain new authorizations as needed. Serve as a support for reimbursement and collections. Other job duties and special projects as assigned.

Requirements

A thorough understanding of EMR, intake requirements, billing and authorization practices is necessary.
Excellent internal teammates, trackers and communicators.
Apply prior and current knowledge of insurance carrier requirements and authorization practices to capture and communicate appropriate clinical and financial data required to obtain approval/authorization of service, professionally documenting the detailed outcome of this process in EMR
Possess professional telecommunication skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrier representatives and internal teams in order to facilitate the referral process and obtain complete information required to initiate a patient's start of care.

Nice To Haves

2+ Years’ experience working directly with payers to obtain authorizations.
Experience with CPR+& working knowledge of Home Infusion, Durable Medical Equipment and Enteral Nutrition Therapy
Self-motivated with ability to prioritize workload to ensure maximum efficiency.
Exceptional communication (verbal and written), critical thinking & problem solving skills.
Must have the ability to work well under pressure to meet timelines.

Responsibilities

Coordination of electronic documents related to nutritional support lines of business.
Timely handling, entry and distribution of documents.
Follow through on referrals, authorization, audits and the like.
Communicate with internal and external customers in order to efficiently and effectively bring a patient from referral through start of care, and to support ongoing service.
Maintain accurate records and keeps current Progress Notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts.
Gather and document a detailed and comprehensive understanding of the various insurance plans and benefits for the different payor classes (State Medicaid, Commercial insurance and Medicare plans) and being able to effectively communicate the therapy and coverage requirements to the Referral source, Patient and Payor sources.
Extensive background working directly with payers to efficiently obtain authorizations to include gap/network exceptions.
Apply prior and current knowledge of insurance carrier requirements and authorization practices to capture and communicate appropriate clinical and financial data required to obtain approval/authorization of service, professionally documenting the detailed outcome of this process in EMR
Possess professional telecommunication skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrier representatives and internal teams in order to facilitate the referral process and obtain complete information required to initiate a patient's start of care.
Receive and process requests for ongoing patient maintenance including RX changes & patient status changes.
Completing reverifications and obtaining new authorizations as required.
Serve as a point of contact for patient/ referral source concerns & performing shipment tracking.
Accurately enter and update patient orders in the EMR.
Ensure all line items are under the appropriate orders for correct billing.
Review "Ready to Bill" for intake codes.
Identify the reason for the hold, and work to resolve issue.
Communicate with billing department once resolution is achieved.
Review patents on "hold" status under intake codes.
Identify the reason for the hold, and work to resolve issue to allow services to resume.
Perform yearly reverifications for active patients, update information in EMR and obtain new authorizations as needed.
Serve as a support for reimbursement and collections.