Description
Summary:
Ensures compliance with managed care, commercial insurance, and public insurance requirements. Submits and tracks referrals. Provides efficient patient flow and service excellence.
Work Schedule: Full Time Days
Responsibilities:
Verifies eligibility and benefits; obtains authorizations for treatment or precertification of high cost drugs. Tracks referrals to ensure compliance with guidelines. Tracks formulary requirements.
Responds to third party payors, employers, internal staff, and physician questions. Maintains information on health plan guidelines. Provides training on plan requirements. Obtains Advance Beneficiary Notice (ABN) or Notice of Exclusions from Medicare Benefits (NEMB) if required. Ensures provider compliance with plan guidelines.
Ensures confidentiality of patient and institutional information. Provides routine information to customers and relays information appropriately.
Monitors patient needs and responds to inquiries. Prepares written reports.
Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.
Requirements:
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