Intake and Authorization Specialist-Infusion center

Sands Health is looking for an experienced and motivated Intake Specialist to join our dynamic team. The Intake Specialist role is a full-time position responsible for providing patient access to the medication and therapies needed by contacting insurance companies and verifying the patient’s health insurance eligibility, benefits, coverage/non-coverage information and initiation/extension of authorizations.

The perfect candidate should have outstanding communication and time management skills, extreme attention to detail and accuracy, have in-depth knowledge of insurance benefit verification, and work in compliance with Federal and State rules and regulations.

Sands Health offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, 401K plan with a generous employer match, remote work from home opportunity, growth, and more.

REQUIRED EDUCATION AND EXPERIENCE:

A high school diploma or general education degree (GED) equivalent is required; minimum 2 years’ experience in customer service, medical billing, benefits verification, healthcare, or similar vocations.

Experience with home infusion or infusion centers is required.
Specialty infusion experience is required (IVIG, Biologics).

ESSENTIAL DUTIES AND RESPONSIBILITIES:

· Enter all required demographic, physician, insurance, authorization, and other information into a profile for all new patients.

· Review all incoming faxed prescription orders and attach to new or existing patient profile.

Evaluates patients on preferred site of administration / Home infusion vs Infusion Center.

· Contact patient or physician to fill in any missing information.

· Conduct comprehensive benefit investigation for new patient referrals. Evaluate pharmacy benefit plans and medical benefit plans.

· Obtain clinical, lab, and medical testing documentation from physicians’ offices for submission of prior authorization.

· Perform timely follow up on authorizations through the process until approved.

· Communicate with patients, physicians, and other departments on benefits and the status of authorization requests.

· Communicate denials to physicians’ offices and provide follow up details on the peer to peer or appeal options.

· Regularly communicate the status of the intake process to other departments, including Nursing, Pharmacy and Sales.

· Notify patients/families/referral sources regarding coverage and payment responsibilities as necessary.

· Provide explanation and paperwork for Copay and financial assistance programs

· Document in the patient’s clinical record progress notes, all requests and conversations for the purposes of seamless coordination of care.

· Identify in-network or mandated pharmacy providers if unable to service a patient due to insurance constraints. Communicate related information to the patient and the physician offices and triage referral as directed.

· Other duties as assigned

PREFERRED EXPEREINCE :

Caretend or WeInfuse software knowledge

Hemophilia experience is preferred

QUALIFICATION REQUIREMENTS:

· Ability to communicate effectively and professionally with patients, physicians, and coworkers.

· Ability to make decisions, solve problems, and work independently with minimal supervision.

· Proven knowledge and complete utilization of processes, systems and techniques to ensure successful authorization.

· Demonstrate excellent leadership capabilities.

· Enjoys working in a team-oriented, service-focused environment.

· Demonstrate extreme attention to detail and accuracy.

· Ability to prioritize and meet deadlines.

· Basic computer proficiency.

· Knowledge in the use of Microsoft applications.

Job Type: Full-time

Pay: From $25.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Home infusion or infusion center: 2 years (Required)
• Supervising: 1 year (Preferred)

Location:

• Texas (Required)

Work Location: Remote