The Intake Coordinator acts as a liaison between the referral source and the Pharmacy to ensure a seamless transition from the acute care setting to home care for our patients.
Establishes and maintains relationships with referral sources by receiving and processing intake information for potential patients who require home infusion therapy
Facilitates intake process by procuring all patient information necessary to determine home infusion admission based on supportive clinical data, prescribed therapy, assignment of home infusion benefits, and following all patient acceptance criteria policies and procedures
Identifies participating payers and contractual pricing agreements
Verifies health insurance coverage using verification forms
Inquires about case management, with authorization number and pre-certification
Obtains/maintains authorization numbers
Performs case management updates for changes in therapy and patient status
Once verification is complete and admission criteria is reviewed/approved by clinical staff, contacts referral source to notify of acceptance or denial of referral
When needed, coordinates the discharge plan with the referral source/discharge planner, nursing agency when applicable, pharmacy, and patient/caregiver
Establishes relationships with licensed and certified nursing agencies to provide clinical nursing services to pharmacy patients
Notifies patient or approved patient advocate and explains their financial responsibilities
Completes all applicable sections of Intake and Confirmation forms, and enters into CPR+
Negotiates pricing with case management under the direct supervision of Center Manager
Assists with the creation and maintenance of Medicare CMNs
Obtains and tracks authorizations
Completes monthly re-verification of Medicaid recipients
Documents credit and cash co-payments made at location level
Obtains clinical documentation necessary for billing
Responsible for the intake of personal referrals
Data-entry and updating patients' demographic information
Insurance benefit verification and coordination with nursing and pharmacy staff
Prepares and manages paperwork and documentation for billing and collections
Resolves patient/payee issues in a timely manner
EDUCATION/EXPERIENCE
high school diploma or equivalent
2-5 years of medical terminology, insurance verification, and/or medical services experience required
1-2 years of experience with home infusion preferred
Experience with ICD-9 coding preferred
College degree is desirable
2-3 years experience with home care, discharge planning, or insurance billing a plus