INFUSION BENEFITS COORDINATOR

JOB TITLE: Infusion Benefits Coordinator

Sign on Bonus with Excellent Pay & Benefits

SUMMARY:

Join us at Arthritis and Rheumatism Associates!

We are a dynamic and creative team who are leading the way in healthcare innovation as we set the standard on optimum patient care. We offer competitive pay and excellent work-life balance with our 4-day work week (closed Fridays).

• 4-DAY WORK WEEK
• SIGN-ON BONUS
• FREE PARKING
• VERY COMPETITIVE PAY AND BENEFITS PACKAGE

GENERAL SUMMARY OF DUTIES:

Interaction with practice business associates, physicians and patients as required. Investigate and coordinate all patient infusion benefits and options. Verify that infusion orders, referrals, and/or prior authorizations are obtained prior to infusion treatments. Calculate patient financial responsibility estimates for infusion services that will be administered. Counsel patients on the findings from our benefit investigations. Assist patients with enrollment to copay assistance programs. Update and verify new insurances when required. Schedule all initial infusion appointments and set appointment alerts for check-in/out staff. Schedule follow-up infusions, office visits, labs, and DEXA’s when necessary.

SUPERVISION RECEIVED: Reports to the Infusion Benefits Manager

SUPERVISION EXERCISED: None

TYPICAL WORKING CONDITIONS: Normal office environment

TYPICAL PHYSICAL DEMANDS:

Requires sitting for long periods of time. Requires eyesight that is correctable to 20/20. Some bending, lifting, and stretching required. Working under stress and deadlines. Frequent use of telephone and computers required. Manual dexterity required for use of calculator, computer, and other common office equipment/machines. Good oral and written communication skills required.

EXAMPLES OF DUTIES: (This list may not include all the duties assigned)

• Stay up to date on all infusion drugs used and the respective pharmaceutical companies and their assistance programs.
• Stay up to date on all accepted insurances.
• Review and accepts order assignments in ReferralMD.
• Update order statuses in ReferralMD and document any needed conversations or events.
• Verify that the drug ordered in EHR is the same drug that is preauthorized, in the OOP alert, and in the appointment book.
• Call insurance carriers for eligibility and benefit verification.
• Submit for prior authorization or predetermination to payers when needed.
• Enter authorizations under the insurance in EPM and create authorization alerts in the patient chart.
• Place yearly alerts with benefits information obtained in the investigation.
• Assist patients with their enrollment to assistance programs.
• Schedule/Cancel/Reschedule infusion, doctors, labs, and DEXA appointments in NextGen EPM.
• Review scheduled appointments and create out-of-pocket alerts and counsel patients when needed.
• When creating OOPs, review and counsel the patient any financial balances and include them in the amount to be collected.
• Document all information on Pre-Infusion log and scan completed paperwork to the patient’s chart. Use the Pre-Infusion Checklist to also generate BI log documents in EHR.
• Email physicians to provide updates on any delays with scheduling.
• Assist Business Office with:
  • Following up on infusion appeals
  • Accounts for indigent infusion patients
  • Infusion billing errors
  • Billing inquiries
• Become familiar and utilize ICD-10 and CPT coding to maximize infusion functions and assist the reimbursement processes.
• Arrange the delivery for free and specialty pharmacy drugs when needed.
• Assist with incoming phone calls to the Arise mainline when possible.
• Handle infusion problem accounts and/or patients to resolution.
• Participate in educational activities.
• Other Duties as Assigned: The assignment of duties to employees is not limited to the content of this job description. Other tasks and assignments may be related to the work usually assigned to the employee, but in some circumstances may be completely unrelated.

PERFORMANCE REQUIREMENTS:

Knowledge, Skills and Abilities

• Must possess good interpersonal and communication skills to facilitate interaction with staff, patients and business contacts.
• Must possess a professional and responsible attitude.
• Knowledge of infusion billing practices.
• Knowledge of infusion medical coding.
• Knowledge of insurance infusion billing practices.
• Skill with computer applications and use of calculator.
• Ability to communicate clearly and effectively with staff, patients, practice business associates, physicians, and others.
• Ability to effectively communicate in writing.
• Knowledge of HIPAA.

COMPLIANCE:

• Follows compliance requirements mandated by CMS, Medicare and all other ARA contracted carriers.
• Knowledge of financial and coding practices necessary to ensure the accurate submission of infusion charges for services rendered in accordance with all federal, state, and local regulations.
• Follows guidelines for maintaining patient confidentiality.
• Demonstrates a strong commitment to honest and responsible corporate conduct.
• Identifies reports and/or prevents any fraudulent or unethical behavior.
• Initiates notification to management if inappropriate behavior is observed within the organization.

HIPAA-Minimum Necessary Access to PHI

The responsibilities associated with this position allow access to the computer role of Infusion only.

We are committed to enforcing minimum necessary access to our patients’ PHIby limiting the uses and disclosures of this information within our practice. For this employee to carry out his/her job (carry out TPO) in a manner that best serves our patients, the employee needs access the afore mentioned computer role. Role descriptions are explicitly defined in our HIPAA manual. Access to computer information is password protected. Upon termination of an employee, his/her password will be deleted from the system.

EDUCATION:

High School diploma, AA or BS degree preferred.

EXPERIENCE:

At least two years of experience working in physicians’ office and/or infusion center. Experience dealing with insurance companies and billing are preferred.

DISCLAIMER:

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.