Option Care Health

Collections

• Submits timely, accurate invoices to payer for products and services provided.
• Understands the terms and fee schedule for all contracts for which invoices are submitted.
• Correctly determines quantities and prices for drugs billed.
• Verifies that the services and products are correctly authorized and that required documentation is on file.
• Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Evaluates payments received for correctness and applies payments accurately to the system.
• Verifies that payments received are correct according to the fee schedule.
• Applies the payment correctly to the patient account.
• Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment.
• Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service.
• Transfers payments belonging to other offices within 48 hours of receipt.
• Follows up on invoices submitted to ensure prompt and timely payment.
• Calls to verify that claims submitted were received and are in processing.
• Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame.
• Generates and mails statements and collections letters.
• Follows-up on all denials within 48 hours of receipt.
• Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule.
• Follows HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.

RCM, Collections Specialist, Medical Biller

Manager

• Determines suitability of patients for home care.
• Supervises, monitors and evaluates the quality and effectiveness of patient care provided by pharmacy staff.
• Manages daily activities with regards to effective operations and communications.
• Directs the activities of the pharmacy department.
• Schedules work activities of pharmacy staff so that the pharmaceutical-care needs of the patients are met.
• Develops and mentors staff through on-boarding, open communication, training and development opportunities and performance management processes.
• Oversees product purchasing, inventory, budget and equipment management.
• Assists the General Manager in preparing, securing approval for, and implementing operating and expenditure budgets for department, and operates within those guidelines.
• Evaluates and oversees the purchase, management and security of all medications, pumps and medical supplies in accordance with the Option Care policies and formulary guidelines.
• Provides support to sales professionals and general manager by speaking knowledgeably of the scope of services that are available through Option Care.
• Meets with managed care organizations and other accounts to facilitate education regarding available services.
• Collects and organizes all patient-specific information needed to prevent, detect, and resolve medication-related problems and to make appropriate medication therapy recommendations.
• Monitors the clinical staff’s documentation on pharmacy care plans for home care patients based on evaluation of monitoring data and other pertinent patient-specific information.
• Evaluates competency in the use of pharmacokinetic principles and formulas and competency.
• Ensures that medications are prepared and dispensed using appropriate techniques and following Option Care policies and procedures.
• Coordinates and participates in on-call responsibilities of the pharmacy department. Ensures reliable pharmacy coverage for on-call activities.

Pharmacy Manager

Collections Specialist, Medical Biller

Director

• Directs the activities of the nursing department(s) for assigned location(s)
• Oversight of work schedules and activities of nursing staff so that the patient care needs are met, productivity standards are maintained, and overtime is controlled
• Works with the Area Director of Nursing to implement and operationalize the centralized scheduling model in the area following the outlined process for centralized nurse scheduling and administrative responsibilities for their location(s)
• Complies with requirements of the Company and ensures that services are provided in a manner consistent with established standards of practice, federal and state regulations, accreditation standards and agency policy
• Ensures compliance with policies and procedures by the department and oversees the selection, development, and monitoring of nursing staff in assigned location(s)
• Partners with the Nurse Manager and/or Nursing Supervisor on the supervision and evaluation of all nursing personnel who provide direct patient care and directs all human resource issues related to nursing and allied health services personnel, including recruitment, performance evaluations, disciplines, and terminations
• Partners with each location to ensure that all nurses providing care maintain professional standards of nursing practice
• Support and drive supply formulary compliance by ensuring that nurses are monitoring patient supplies and maintaining adequate levels
• Assists Operations Leadership in preparing, securing approval for, and implementing operating and expenditure budgets for department, and operates within those guidelines
• Responsible for the coordination of patient services with the pharmacy, delivery, reimbursement, and other departments both internally and externally
• Establishes and ensures the purchase and expedition of medical supplies and equipment within budget constraints
• Participates in the process for assessing, managing, and reporting nursing operational and financial data to Operations Leaders, including analysis for trends and development of process improvement plans
• Ensures each location has a process to collect and organize all patient-specific information needed to determine the suitability of patients for home care
• Assesses patients’ suitability for home care in accordance with Option Care Health policies
• Verifies that the patient’s medical condition and prescribed therapy is suitable for home care
• Provides continuing education to physicians, nurses, pharmacy technicians, and other practitioners on home care infusion-related issues, including competency and orientation programs
• Ensures each location has a process for on-call responsibilities for the nursing department
• Facilitates a clinical networking system for the agency and acts as a clinical resource
• Meets all standards as outlined in all Nursing Leadership job descriptions

Director of Nursing

Account Executive

• Responsible for sales and marketing efforts in a specified territory and for growing top line revenue and margin of assigned therapies.Creates a territory sales plan and regularly assesses progress on opportunities.Uses appropriate marketing materials and tools to convey consistent messaging across the organization.Manages the sales process that ultimately results in customer commitment to Option Care.Researches, develops and implements sales strategies for assigned territory.Present partnership opportunities to health system leaders, decision makers and referral sources to drive new business growth for Option Care.Quantify value of partnership and financial/economic terms to decision makers.Prioritizes accounts based on total potential, current referrals, likely profitability, service needs, and probability of success.Uses available information, including internal information and third party data, to understand customer needs and identify opportunities.Creates and updates short-and long-term account plans and objectives; utilizes to guide actions.Tracks activity and process toward objectives.Communicates sales strategies to key internal partners, i.e. Clinical Liaison and Branch staff, including soliciting input and feedback on proposed strategies.Manage multiple internal (CL, Intake, Branch Staff) and External (case manager, hospital administration) relationships and process to ensure customers are set up to succeed.Frequently initiate communication with Clinical Liaison to identify new opportunities and check on progress toward defined goals.Identifies key customer decision makers and builds relationships to gain access to all decision makers.Assesses and documents the competitive landscape within the account (e.g. pre-existing competitor relationships, presence of clinical liaison, etc.).Partner with internal team members (Specialty Sales, Clinical Liaison, RSD, Nursing) who provide specialized knowledge and experience to grow relationships and sales with health system leaders.Conveys and reinforces elements of the value proposition appropriate for each account and decision maker.Adjusts messaging based on customer relationship life-cycle (e.g. potential new account vs. long-standing, loyal referral source).Obtains a complete understanding of customer needs before offering a solution.Leverages resources within including GMs, first line managers, Clinical staff, specialty sales, nursing and other sales roles—to assist in addressing customer issues.Manage time and schedule to prioritize business growth, and partner with other Option Care partners to focus on service excellence.Successfully organize multiple, on-going work streams, internal partnerships and growth opportunities.

Account Executive / Account Therapies

Job Description Summary: This role is responsible for the more complex and large account negotiations, preparation, financial analysis, business review, and implementation of assigned Managed Care clients, 340B, and Health System Partnership agreements for home and alternate site infusion services provided by Option Care.
Responsible for managed care plans with greater than 250K lives that require more complex negotiation and relationship management.
Resolve reimbursement issues arising from contract compliance issues for assigned regions when escalated by Revenue Cycle Management team.
Manage the negotiation of managed care and health system contracts in accordance with company guidelines for assigned geography for home and alternate site infusion therapy services provided by Option Care
Oversee internal implementations of assigned agreements with regional intake, operations, and revenue cycle teams in order to insure success of clean claims payment.
Manage external implementations and foster ongoing relationships with assigned accounts
Manage communication with assigned accounts as it relates to demographic changes to Option Care Facilities to insure health plan agreements are current in order to facilitate clean claim billing.
Initiate and lead meetings with health plans and corporate teams, including Managed Markets and Contracting leadership, to review provider agreement performance data and scorecards.
Informs contracting leadership of contract risks for assigned third party contracts.
Recommends course of action to reduce/minimize risk to the organization.
Identifies, and assesses impact of potential changes in the industry or changes related to new state or federal legislation.
Resolve reimbursement issues identified by Payer Liaisons that may be related to contract compliance.
Strategize with AVP MMS on plans to update and grow a sales representative’s understanding of the scope and intent of assigned managed care or facility contracts.
Attends client meetings where appropriate and in collaboration with assigned managed markets representative.
Maintains successful working relationships with internal departments such as Infusion Operations, Legal, Sales, and any other departments that are involved with or impacted by managed care contracts.
Complete credentialing applications when necessary for new contract access as back up to contract coordinator.
Participate in regional meetings as directed by VP, Contracting

RCM, Collections Specialist, Medical Biller

Pharmacy Manager

Collections Specialist, Medical Biller

Director of Nursing

Account Executive / Account Therapies

Managed Care AIC Contracts Manager