CarepathRx

Insurance

• Manage the daily functions of the Insurance Verification area including verification of insurance coverage, re-verifying coverage for existing patients, enter and update patient demographics into the computer system, and securing reimbursement related paperwork
• Generate price/coverage quotes
• Work effectively and maintain expected productivity
• Verify insurance coverage, calculate costs and document details in the patient profile
• Generate a financial responsibility letter
• Review benefits with patient via phone
• Track, monitor and secure necessary insurance documents
• Obtain prior authorizations as required
• Coordinate completion of Financial Assistance forms, payment agreements and waivers
• Assist with training new employees
• Organize and prioritize tasks to be completed
• Create new hospital and physician codes as needed
• Give high priority to client satisfaction and customer needs
• Cooperate with other staff members when planning and organizing reimbursement activities
• Demonstrates the ability to work effectively and maintain expected productivity
• Meets quality standards, shows pride in performance, and demonstrates reliability and follow-through on all assigned tasks
• Assist with researching reimbursement issues
• Performs in accordance with system-wide competencies/behaviors
• Performs other duties as assigned

Insurance Verification Coordinator

Onboarding Specialist

• Obtains the patient referral via phone, fax, email and/or EMR
• Documents the referral details by creating the patient information sheet
• Identifies and documents the patient’s team assignment
• Creates patient entry for delivery management
• Enters/updates the patient profile, progress notes and home health information
• Acts as liaison between internal teams and the referral source
• Receives incoming calls, taking patient markers for new referrals
• Uploads documents to the patient’s medical record
• Manages electronic fax folder, determining the appropriate destination for the file
• Coordinates home health needs for the patient
• Acts as the team point of contact for assigned referral sources and/or therapies
• Assists with complex referrals/home health cases
• Trains/mentors new team members
• Assists Intake nurses with faxing and copying and distribution as needed
• Performs in accordance with system-wide competencies/behaviors.
• Performs other duties as assigned

• Responsible for performing select activities related to the clinical management and order setup of specialty patients under the supervision of a licensed pharmacist
• Provide support to specialty pharmacy team, pharmacy distribution and operations including but not limited onboarding of new Specialty patients
• Maintain and update patient information and medication profiles, complete patient assessments and medication delivery setup under direct supervision of a licensed pharmacist
• Provide appropriate and accurate documentation in patient medical record
• Accurately provide copay information to the patient and process payments

Onboarding Coordinator – Specialty

Financial Planning and Analysis

• Responsible for the billing and collection of copay assistance programs and foundation claims
• Identify billing trends
• Identify errors, correct claims and reprocess for reimbursement
• Read and interpret an EOB for accurate understanding of denial
• Contact payer, or patient as appropriate
• Document all collections activity in patient collections notes
• Document work performed/action taken on AR Aging Report and/or Over/Under Report
• Process all Payer appeal requests within the timeframe required by the Payer
• Ensure the timeliness and accuracy of billing
• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management

Financial Assistance Specialist

• Obtains patient referral data from referral sources via phone
• Answer incoming phone calls pertaining to referrals
• Perform clerical duties as requested
• Documents initial referral information
• Identifies and documents patient team assignment
• Notifies intake coordinator of pending referrals
• Enters new patient information into computer system as needed
• Assists Intake with phone communication as needed
• Assures accurate transfer of patient insurance information
• Provides customer service to internal and external customers
• Performs in accordance with system-wide competencies/behaviors
• Performs other duties as assigned

Billing Specialist

Accounts Receivable Specialist is responsible for maintaining timely and accurate account receivables claims and systems. Responsibilities Verify all data around patient/claim and find out why it has been denied
Responsible for timely re-submission and accuracy for billing claims
Responsible for accurate submission of necessary documentation to the insurance companies with claims
Follow-up on all denials within 72 hours of receipt
Participate in accurate collection activities and accounts receivable management. This includes mailing second and third notices to past due accounts and letters of patient responsibility
Obtaining prior authorizations and medical records both via portals and phone
Post payments to accounts and submit check requests for accounts overpaid
Manage accounts receivable to reflect collectable dollars
Responsible for knowing and complying with applicable policies and procedures
Answering/handling incoming calls regarding claims that were billed/denied to both patients and insurance companies.
Making outbound calls to patients regarding need of updated insurance, documentation needed for continuation of care and billing insurances, prior authorizations, picking up rental equipment, transitioning care, etc.
Other duties as assigned