Salary Range:
$26.00 To $27.00 Hourly
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, manufacturer program support, and direct patient communications to relay benefit coverage and financial liability.
Essential Job Duties:
- Coordinate electronic documents related to digital therapy support lines of business and ensuring timely handling, entry and distribution of these documents. This is inclusive of follow through on referrals, authorization, audits and the like.
- 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.
- Serve as the single point of contact for external customers and provide white glove service for all patients in the program. Serve as a point of contact for patient, referral source and manufacturer concerns, and performing shipment tracking as well as assist with reimbursement and collections.
- Possess professional telecommunication skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrier representatives, manufacturer, and internal teams in order to facilitate the referral process and obtain complete information required to initiate a patient’s start of care.
- 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 CPR+.
- Receive and process requests for ongoing patient maintenance including RX changes & patient status changes. Completing reverifications and obtaining new authorizations as required. Accurately enter and update patient orders in the EMR. Ensure all line items are under the appropriate orders for correct billing.
- Maintain accurate records and keep current progress notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts.
- 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.
*Other job duties and special projects as assigned.
Ideal Candidate Will Have:
- High school diploma or equivalent with 2+ years’ experience working directly with payers to obtain authorizations. Extensive background working directly with payers to efficiently obtain authorizations to include gap/network exceptions.
- A thorough understanding of CPR+, intake requirements, billing and authorization practices is necessary. Must be excellent with teamwork and communication with internal and external customers, patients and prescribers.
- Self-motivated with ability to prioritize workload to ensure maximum efficiency. Exceptional attention to detail, track record of customer satisfaction and ability to work well under pressure and meet deadlines. Exceptional organizational, process, critical thinking and problem-solving skills.
- Exceptional verbal and written communication skills and proficient computer skills (MS Word, Excel, PowerPoint).
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to travel via car, train or plane, stand, sit, walk, see, hear, use hands and fingers regularly, handle, or feel objects, tools, or controls, and reach with hands and arms.
The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 40 pounds
Salary Range: $26 per hour
Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.
Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
