About the Role:

The Infusion Intake Coordinator I plays a crucial role in the healthcare system by ensuring that patients receive timely and accurate infusion therapy services. This position involves coordinating patient intake processes, verifying insurance information, and facilitating communication between patients, healthcare providers, and insurance companies. The coordinator will be responsible for maintaining detailed records and ensuring compliance with healthcare regulations. By effectively managing the intake process, the coordinator helps to streamline patient care and improve overall patient satisfaction. Ultimately, this role contributes to the efficient delivery of essential healthcare services, making a significant impact on patient outcomes.

Minimum Qualifications:

Associate's degree with 2 years or any combination of education and
work experience in a customer service-related role.
Prior experience obtaining insurance prior authorizations, pre-determinations, pre-certifications and an understanding of insurance coverages and participation.
Previous experience in a healthcare setting, preferably in patient intake or coordination.
Previous experience working in a medical/clinical setting.
HIPPA compliance regarding PHI.
Working knowledge of computers, internet access, and the
ability to navigate within Microsoft Office Suite, or similar programs.
Demonstrated excellent verbal and written communication skills.
Excellent phone and written skill

Preferred Qualifications:

• Bachelor’s Degree.

• Bilingual (English/Spanish) strongly preferred but not required.

• Prior experience in Rheumatology.

• Experience with NextGen and Availity software.

• High degree of ownership, attention to detail, and trustworthiness required.

• Able to work in a high volume/fast-paced environment.

• Ability to work successfully within a team-oriented atmosphere.

Responsibilities:

• Responsible for requesting, receiving and inputting incoming prior authorizations, patient information, and eligibility data accurately and timely into the Electronic Medical Records (EMR) system.

• Responsible for viewing requests and clinical packets to ensure all necessary information is included and accurate.

• Responsible for scrubbing schedules to ensure patients have complete and necessary insurance and claims information to complete the process.

• Verifies all diagnosis codes for accuracy and to ensure they meet reimbursement/payables eligibility.

• Performs insurance benefit verification and prior authorization for each patient and secures pre-determinations if prior authorizations have not been

obtained.

• Responsible for maintaining prior authorization and pre-determination communications regarding status/receiving request and submitting appeal and

peer-to-peer letters.

• Responsible for maintaining the online share file so all information is entered and current and accurate.

• Enrolls patients with Pharmaceutical Copay Assist Programs per eligibility requirements.

• Responsible for the accurate communication of financial policies to patients.

• Monitors the daily infusion schedule and schedules patients accordingly.

• Responsible for the complete, accurate and timely data entry of patient insurance verification/authorization forms and demographic information into the

EMR system.

• Responsible to assist Lead in investigating denial claims as needed.

• Responsible for maintaining a high level of constant attention to detail, critical thinking and problem solving, to resolve issues as they arise.

• Other duties as assigned.

Skills:

The required skills for this position include strong organizational abilities, attention to detail, and effective communication skills, which are essential for managing patient information and coordinating with various stakeholders. Proficiency in using computer systems and software is necessary for maintaining accurate records and processing insurance claims. Preferred skills such as familiarity with EHR systems enhance the coordinator's ability to streamline workflows and improve data management. Additionally, problem-solving skills are vital for addressing any issues that may arise during the intake process. Overall, these skills contribute to a smooth and efficient patient experience, ensuring that individuals receive the care they need in a timely manner.

Pinnacle Healthcare Consulting LLC

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Infusion Intake Coordinator I