Specialty Products Patient Care Coordinator

The Specialty Products Patient Care Coordinator is accountable for the intake functions & ongoing maintenance of Pentec’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.

Essential Job Duties

• Accountable for the coordination of electronic documents related to nutritional support lines of business. Handle timely entry and distribution of these documents including follow through on referrals, authorization, audits and the like. Communicate well with internal and external customers in order to efficiently and effectively bring a patient from referral through start of care, and to support ongoing service.
• Maintain accurate records, keep current progress notes to streamline reporting functions and ensure adequate information is available in support of positive cash flow and collection efforts. 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). Able to effectively communicate therapy and coverage requirements to the Referral source, Patient and Payor sources.
• 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 EMR. Accurately enter and update patient orders in the EMR.
• 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.
• Receive and process requests for ongoing patient maintenance including RX changes & patient status changes. Completing reverifications and obtaining new authorizations as required. Serve as a point of contact for patient/referral source concerns & performing shipment tracking. 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 patients 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.
• Other job duties and special projects as assigned.
  
  

Ideal Candidate Will Have

• High School Diploma or equivalent with 2+ Years’ experience working directly with payers to obtain authorizations. *Required*
• Experience with CPR+ and working knowledge of Home Infusion, Durable Medical Equipment and Enteral Nutrition Therapy. Extensive background working directly with payers to efficiently obtain authorizations to include gap/network exceptions.
• Self-motivated with ability to prioritize workload to ensure maximum efficiency. Exceptional communication (verbal and written), critical thinking & problem-solving skills. Must have the ability to work well under pressure to meet timelines.
• A thorough understanding of EMR, intake requirements, billing and authorization practices is necessary. Must be excellent internal teammates, trackers and communicators.
  
  

Salary Range: $26.44/hr (55,000 annually)

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.

Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits