Home Infusion Intake Coordinator; Mount Sinai Morningside; Full Time Days

The Home Infusion Intake Coordinator is responsible for insurance verification, conducting and completing necessary third party (insurance) prior authorization requests, patient out of pocket estimates, patient notification of co-insurance, co-payments and deductible for all treatment plans, patient enrollment in all applicable co-pay programs, foundations and free drug programs to assist with out of pocket expenses, referral for Medicaid/charity care assistance when applicable, billing to co-pay programs and foundations, and co-pay program credit card processing for all patients in our Mount Sinai Home Infusion program. Interacts with hospital employees on multiple levels, including pharmacists, medical/clinical staff, fiscal personnel, department managers, access services staff, coding staff and billing assistants.

1. Verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information.

2. Completes third party prior authorization requests and verifies prescriptions

3 Using an Estimator tool, calculate estimate for out of pocket expenses for treatment plan based on their current insurance benefits and hospital contracts.

4. Based on out of pocket expenses, determine if patient is eligible for any drug Co-pay Assistance Programs, foundations or if best option for the patient is a referral to the Medicaid Application team for possible charity care enrollment.

5. Clearly communicate to the patient their financial obligations and work with patient to get them enrolled in any/all relevant assistance programs, ensuring the patient understands the programs and their financial responsibility with and without program assistance. Answer any questions the patient might have.

6. Maintains contact with prospective patients who may need continued assurances and encouragement to engage in treatment.

7. Document patient program enrollment and effective dates in all applicable systems and spreadsheets. Update patient scheduled appointments with the appropriate Co-pay Program financial class.

8. Notify clinical team, scheduling team, and patient of any delays in financial clearance issues which might delay their treatment start date.

Submit claims with attachments and required claim forms when required, to Co-pay Assistance programs or foundations for patient co-pay, deductibles and co-ins. This will require downloading claims explanation of benefit documents from all relevant payer web sites.

10. Follow-up with third party groups to ensure Patient Assistance Program claims are received and processed.

11. Answer all patient, third party and other department email and/or phone requests regarding billing issues or program enrollment issues.

12. Assist in the coordination of onboarding process, including but not limited to: ensuring complete order from provider; scheduling of nursing visit; coordinating pharmacy medication management/340B qualifying visit

13. Utilizes Epic and Mount Sinai Home Infusion’s electronic medical record to document financial clearance status and patient responsibility.

14. Processes cash deposits and addresses mail received related to authorizations and billing

15. Cross-trained to support all service lines, treatments, and payers.

16. Remains up to date on all new drugs and financial assistance programs they offer.

17. Keeps abreast of coverage updates to on all foundation programs and which programs have available funding for a covered diagnosis.

18. Schedule is varied to meet the needs of the service sites and ancillary departments.

19. Special projects as assigned by supervisor or manager

 

 

• HS/GED; Associates degree or higher preferred
• 1 year of retail pharmacy technician experience
• 3 years of health care related billing and/or retail pharmacy experience preferred

 

Non-Bargaining Unit, LAI - HSO Pharmacy Home Infusion- STL, Mount Sinai St. Luke's

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