Pre-Cert Coordinator - Infusion

Essential Functions

• Verifying benefits and eligibility for both new and existing patients to process patient benefits in a timely manner; including necessary prior authorizations
• Calculates patient due portions based on insurance and pharmacy verification
• Communicates with patient on their payment expectations
• Understanding insurance carriers and concepts including drug cards, major medical and pharmacy benefits, and knowledge of government and patient assistance programs
• Validating patient copay assistance programs
• Processing all outside infusion referrals
• Reviewing payment records for patients and third parties, ensuring fees are collected properly
• Answering phone calls and returning voicemails in a timely manner
• Checking and resolving assigned tasks in Electronic Health Record

Knowledge Performance Requirements

• Pharmacy, PBM, or Specialty pharmacy experience a plus
• Knowledge of government and patient assistance programs
• Excellent customer service skills
• Attention to detail
• Analytical and problem solving skills
• Knowledge of Medicare, Medicaid, and third party vendors
• Proficient in Microsoft - Able to type 50 words per minute
• EHR system experience
• Office (Outlook, Word, Excel, PowerPoint)

Qualifications

• Associate’s or Bachelor’s degree in healthcare, business, finance, other related field, or equivalent experience, a plus
• 2-3 years of experience with medical insurance, benefits verification, prior authorizations, medical billing, or a related field

Physical Requirements

• Ability to work effectively in a fast-paced environment
• Physical ability to sit, perform data entry and view computer screen for long periods at a time
• Occasional exposure to communicable diseases and biohazards
• Daily standing, walking, bending, and maneuvering
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices

Scheduled Working Hours

• Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays.
• Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties

• Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job.
• Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment Operated

• Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.