Pentec Health
OBJECTIVE:
Under the direct management of a Supervisor/Manager, 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, and direct patient communications to relay benefit coverage and financial liability.
Critical features of this job are described under the headings below. They may be subject to change at any time due to reasonable accommodation or other reasons
ESSENTIAL DUTIES AND RESPONSIBILITIES:
The following tasks are considered to be typical and significant, any one or all of which may be performed by this position:
- 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.
- Possess professional telecommunication skills to effectively articulate benefit information, clinical and financial needs, and/or challenges to patients, referral sources, insurance carrier representatives 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+
- Provide Supervisor/Manager with feedback and suggestions for improving the process, bringing immediate attention to any areas preventing achievement of goals and objectives.
- Communicate well with internal and external customers in order to efficiently and effectively bring a patient from referral through start of care.
- Ensure timely follow-up and accurate notation of progress made on follow-up of all required paperwork in a concise manner.
- Maintains accurate records and keeps current all Progress Notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts.
- Receive and process requests for ongoing patient maintenance including RX changes, patient status changes & modality changes. Completing reverifications and obtaining new authorizations as required.
- Serve as a point of contact for referral source concerns, performing shipment tracking, handling equipment concerns and addressing supply needs.
- Accurately enter and update patient orders in the EMR. Ensure all line items are under the appropriate orders for correct billing.
- 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.
- Serve as a support for reimbursement and collections
- Assists with Performance Improvement activities.
- Performs all other duties assigned by their respective Supervisor
SKILLS, COMPETENCIES AND EXPERIENCE:
Required
- Exceptional computer skills (MS Word, Excel, PowerPoint)
- Exceptional communication verbal and written
- Exposure to supervisory experience
- Exceptional organizational and process skills
- Ability to work well under pressure and meet timelines
- Exceptional critical thinking and problemsolving skills
- Proven performance, history in related field
- Exceptional attention to detail and demonstrated results
- Exceptional track record of customer satisfaction
- Demonstrates the ability to delegate, complete projects through others
Preferred:
- 2+ years of computer data entry experience or related field
- Experience with CPR+
- Working knowledge of Home Infusion, Specialty Infusion, Dialysis, Durable Medical Equipment and/or Nutrition Therapy
EDUCATION, CERTIFICATIONS
Required:
- High School Diploma or equivalent and customer service experience.
Preferred:
- Associate’s Degree or some College in a related field of study/pursuing continued education in related field or equivalent relevant experience preferably working with insurance.
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.