Infusion Intake Specialist II (31900)

Purpose

Review and process infusion services and physician orders in a timely and accurate manner to obtain payment for infusion services.

Responsibilities

• Review physician order for Infusion.
• Verify patient benefits independently and with appropriate manufacturer hub programs.
• Determine whether practice can buy & bill or if medication needs to be obtained through a Specialty Pharmacy.
• Assist patient with foundation copay programs, if eligible for reimbursement program.
• Obtain foundation copay card information once assistance approved.
• Obtain prior-authorization for infusion services from patients insurance company by calling insurance carrier and/or submitting required forms and medical records via fax or online portal.
• If Specialty Pharmacy utilized, submit proper paperwork and patient clinical information.
• Assist in claims payment follow-up involving denials related to authorization or insurance coverage.
• Communicate necessary patient financial information with appropriate office and billing personnel in an efficient, timely and accurate manner.
• Communicate with patient regarding deductibles, copays, co-insurance, and financial assistance coverage.
• Alert supervisor of any roadblocks to timely verification, prior authorizations and payment of infusion claims.
• Provide quality service to patients.
• Abide by all federal, state, and payer requirements and regulations.
• Perform other duties as assigned.

Qualifications

Education: High School Diploma or GED required; associates degree preferred.

Experience: 3–5 years of prior infusion intake experience is preferred. Prior intake experience related to infusion needed.

Requirements for Level II Status

• Intermediate experience (4+ years experience) and/or acting more independently.
• Takes on additional duties to assist the office.
• Strong and consistent performer.

Skills

• Excellent communication skills, both written and verbal.
• Excellent customer service skills are required.
• Proficient computer skills, including MS Office experience, particularly in MS Word and MS Excel.
• Ability to multi-task and work in a fast-paced environment.
• Detail-oriented.
• Strong understanding of healthcare plans.
• Ability to read and understand medical benefits.
• Ability to read and understand payer medical policies.
• Bilingual is a plus.
• Medical terminology (CPT, ICD 10) knowledge.
• Self-motivated with initiative.
• Strong sense of ethics.