Authorization Verification Specialist - Hammonton, NJ 9/14/2016
JOB DESCRIPTIONAPPLY BioScrip, Inc. is one of the nation's leading specialty and home infusion companies! Our focus is clinical excellence and improving the quality of our patients' lives. With over 2,500 employees able to service 46 states, BioScrip has externally-qualified Centers of Excellence built around specific clinical conditions and therapies, as well as Ambulatory Infusion Centers around the country. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of employee benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) plan with a Company match.
Due to our exceptional growth and success, we are recruiting for an Authorization Verification Specialist to join our team.
The Authorization Verification Specialist will work as part of an interdisciplinary team in providing the necessary communication and coordination of services that will maintain all interventions necessary to meet the needs of our BioScrip clients.
To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.
* Responsible for verifying patient benefits and pre-certifications.
* Verifies primary and secondary insurance coverage for patients; makes written and/or verbal inquiries to payers to verify insurance status and pre-certification status.
* Obtains and facilitates all letter of medical necessity (LMN) necessary
* Verifies patient's co-pay/ con-insurance with Payer.
* Contacts patients, physicians and other health care providers to obtain necessary information to complete a thorough insurance investigation. This includes patient eligibility, how drug is covered, co-pay, deductible, and OOP max. Benefits and prior authorization requirements.
* Manage/process all insurance changes related to current patients enrolled in the BioScrip program.
* Logs all co-pay/ co-insurance information into the system.
* Logs patient's insurance information into the system.
* Logs all calls made/received into the system.
* Takes incoming patient/insurance inquiries and follows up to completion on each inquiry.
* Daily status reporting
* Processes all required paperwork according to established procedures. Ensures all documentation needed for billing is collected prior to or soon after accepting the referral.
* Answers telephone calls and emails in a professional and timely manner.
* Attends all required in services throughout the year.
* Each employee is responsible for adhering to those performance programs, policies, procedures, guidelines and internal control standards established to guide the operation of the Company. Each employee must be made aware of and understand proper internal control procedures associated with their specific job function as communicated by his/her manager.
* Each employee is responsible for reporting concerns that he or she may have with respect to deficiencies in internal control.
* Performs other duties as assigned.
EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS
* Associates degree or equivalent experience.
* At least 1 year experience verifying insurance.
* Medical Billing and Coding.
* Medical Claims experience.
* Home infusion experience on the provider or payor side preferred
* Experiential requirements may be waived in lieu of evidence of progressive growth in and attainment of the skills necessary to perform the required duties.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.
* Knowledge of HCPC Codes and ICD-9 Codes and maintains up to date professional knowledge of Medicare, Medicaid and the insurance industry requirements for qualifying services.
* Ability to foster a cooperative work environment.
* Strong interpersonal and communication skills and the ability to work effectively with branch departments.
* Knowledge of computerized information systems, including financial applications.
* Knowledge of infusion pharmacy durable medical and respiratory equipment reimbursement for state, federal and commercial payors.
* Ability to develop and maintain recordkeeping systems and procedures.
* Knowledge of the computer and its capabilities.
* Working knowledge of medical terminology.
* Ability to perform work in an organized fashion with focus on complete information and time related deadlines.
* Ability to complete multiple projects with time sensitive deadlines.
* Ability to manage more than one priority project at a time.
* Ability to work as part of a team to complete assigned tasks.
* Ability to exercise independent judgment and at times work independently.
* Ability to accept direction and complete work according to instruction.
* Ability to enlist cooperation of other people and department in completing assigned work and projects.
* Ability to work under high levels of stress.
* Ability to prioritize and handle multiple tasks and projects concurrently.
* Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.
* Excellent verbal and written communication skills.
* Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office.
* Ability to work with confidential material and maintain confidentiality along with sensitivity to employee's needs and data.
* Strong attention to detail.
* Strong analytical skills.
Ability to read, analyze and interpret information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from referral sources, managers, patients, employees, payors and the general public.
Ability to calculate and perform basic mathematical calculations such as pharmaceutical calculations, discounts, percentages, and volume.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.