SUMMARY:
This position will represent Heritage Medical Associates Infusion Services Department in assisting patients with all financial concerns for patients, insurers, referring/attending physicians, care coordinators, pharmacy staff, and other stakeholders related to medications administered in the clinic/infusion center. The Infusion Financial Specialist will identify payer sources, verify benefit information, complete in-depth payor medical necessity review, and acquire initial authorization as needed to begin patient service or to determine denial of patient service. They will follow up on pending unresolved coverage issues and provider supporting documentation to assist with the appeal for claim denials. The position serves as an integral part of the patient care team while acting as a liaison between patients, care givers and support staff to deliver outstanding service and optimize patient flow. The position will have an in-depth and working knowledge of registration and clinic billing functions that are necessary to resolve the account and any issues brought by the patient.
ESSENTIAL DUTIES AND RESPONSIBLITIES: Other duties may be assigned.
- The Infusion Financial Specialist must verify that all the information is correct on the electronic or written Physician's Order. If there are any discrepancies, the Infusion Financial Specialist must call the provider and/or patient to verify the information and ensure accuracy before the infusion process can be started.
- Verify insurance coverage, determine level of benefits, complete a medical necessity review, ensure payer approvals for high-cost drug therapies prior to patient treatment, solves problems with insurers.
- Work closely with infusion nursing staff, physicians, and other clinical personnel to ensure smooth billing workflows and effective communication regarding patient financial status.
- Responsible for submitting applicable infusion claims in real-time accurately and timely, as well as time corrections through online pharmacy portal (i.e. TransAct Rx).
- Assist Business Office with outstanding infusion services claims, working with insurance companies to resolve any issues, denials, or delays in payment.
- Provide financial support for patients as needed during their treatment communicating options for financial assistance as appropriate; answer related questions to ensure patients' understanding of their benefits.
- Coordinate with drug companies to qualify patients for drug assistance programs, when applicable.
- Maintain current knowledge of payer requirements including use of on-line verification applications and initial and ongoing training.
- Communication with patients, coding, patient access, business office, pharmacy, and clinical staff to gather appropriate information needed to complete daily duties.
- Performs other duties as required/directed.
SUPERVISORY RESPONSIBLITIES
- This job has no supervisory responsibilities.
