This position is responsible for coordinating delivery of drugs and supplies to the patient, assisting in the coordination of home infusion nursing visits, enrolling new patients, handling incoming calls from patients, health care providers and insurance companies; assuring billing accuracy, obtaining insurance eligibility and authorization, and entering patient demographics and medical history into a computerized home infusion software. Responsible for collecting and maintaining data used for verification, authorization and provision of home infusion services. Serves as a liaison between local patient care services, co-workers, equipment providers, physicians clinics, hospitals, third party payors, patients and their family members, regulatory and other community agencies to support appropriate patient care. Also assists in maintaining patient pharmacy records, documentation, and handling of equipment. Reviews account information to optimize collection efforts and system recording events to expedite reimbursement and compliance. Explains and obtains signatures on legal forms and registration materials.
Handles incoming requests for patient referrals and/or requests for services, verifies requests and provides on- going follow-up of requests up to and following patient discharge. Receives supply orders and inquiries from patients and nursing staff. Works with patients, nursing and HME warehouse to generate patient delivery tickets. Ensures adequate levels of supplies are available and arranges the delivery of supplies. Communicates with patients to arrange pickup of unused supplies and rental equipment at the end of therapy. Communicates pricing information to the patient. 1a. Builds referrals using information in patient record to provide minimum data necessary to coordinate patent services.1b. Provides verbal and written instructions to patients, families, and coordinating resources regarding provision of products and services, reimbursement and patient financial responsibility.1c. Performs data entry of patient intake information into computer system, requests for service, pertinent medical history, delivery information, records insurance information and authorization requirements, and supply information in the computerized software system. 1d. Coordinates requested services and referrals with service and equipment providers, pharmacy warehouse, clinical staff and sets delivery expectations between patients and providers.1e. Facilitates problem solving with patients, hospitals, providers, referral sources, insurance companies and clinical staff. Assists in the maintenance and communication of changing payor and referral source information specific to coordination of patient needs.
Verifies that all billable services and supplies have physicians order when needed. Researches billing/activity errors and works with departments to resolve issues and make necessary adjustments. Tracks and obtains authorizations for services, enters them into the system, generates reports to identify expiring authorizations and certifications and communicates to appropriate clinical staff.
Participates in audits of clinical records for billing compliance, completeness and accuracy. Communicates with appropriate staff to correct billing documents and assists in resolving documentation problems.
Performs reimbursement functions including insurance eligibility, benefit verification, obtaining authorization, re-authorization and re-certification for initial and ongoing services in conjunction with Patient Financial Services. Accurately records data into appropriate software system for communication of insurance information and authorization requirements to ensure accurate and timely billing. Calculates patient liability according to verification of insurance benefits, collects deposits and co-payments. Acts as a liaison between the patient, the billing department and the payor to enhance account receivables performance, resolve outstanding issues and/or patient concerns and to maximize service excellence.
Cross-trains, assists and fills in for other team members as necessary to ready pharmaceuticals for delivery. Assists in orientation development of other staff members and in quality improvement activities. Identifies opportunities to improve work processes and practices good work group dynamics.
Creates and maintains daily prescription logs and prescription files and works with the pharmacists and supervisor to keep in compliance with Arizona State Pharmacy. Ensures each admission meets specified criteria. Works to ensure compliance with State, Federal and OSHA and other regulatory standards. Follows all agency and department policy and procedures.
The position requires knowledge normally acquired with completion of a High School Diploma or equivalent.
This position requires skills and abilities typically attained with two years of experience in medical insurance verification and data entry as well as experience in a healthcare setting in a financial services capacity. Must have a working knowledge of medical terminology and be willing to develop basic working knowledge of types of infusion devices and IV/IM/subcutaneous administration supplies, and access/delivery devices. Mathematical aptitude and arithmetic skills in order to correctly calculate doses and quantities of pharmaceuticals for pricing purposes is a must. This position requires excellent written and verbal communication, organizational and interpersonal skills along with time management aptitude. The individual must portray a friendly, helpful demeanor while assisting patients in obtaining necessary services, equipment and supplies as well as when collecting co-payments. An understanding of the components of medical records and regulations regarding the creation and maintenance of medical records as well as the ability to create spreadsheets to analyze and present data is of upmost importance.
Previous cash collections experience.
Additional related education and/or experience preferred.
Internal Number: 213505
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.