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Medication Access Coordinator - OP
Arlington Heights, IL
Job Description
Position Highlights:
A Brief Overview:
Reporting to the Specialty Management team, the Ambulatory Specialty Medication Access Coordinator works with Specialty nurses, physicians, patients, their representatives, insurance carriers and employers to determine benefits eligibility, benefits verification, and prior authorization requirements for high cost medications used in the Medical Group Specialty as well as in home or infusion clinic. The Ambulatory Specialty Medication Access Coordinator screens registration data for compliance to ensure optimal reimbursement for high cost medications and assists with denials and failed claims to ensure maximum reimbursement.
What you will do:
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
- Sign on bonus: (if applicable)
- Position:
- Location: [City, IL]
- Full Time/Part Time: [Full Time / Part Time]
- Hours: Monday-Friday, [hours and flexible work schedules]
- Required Travel:
A Brief Overview:
Reporting to the Specialty Management team, the Ambulatory Specialty Medication Access Coordinator works with Specialty nurses, physicians, patients, their representatives, insurance carriers and employers to determine benefits eligibility, benefits verification, and prior authorization requirements for high cost medications used in the Medical Group Specialty as well as in home or infusion clinic. The Ambulatory Specialty Medication Access Coordinator screens registration data for compliance to ensure optimal reimbursement for high cost medications and assists with denials and failed claims to ensure maximum reimbursement.
What you will do:
- Expedites authorizations for high dollar medications that are given in the office, home, or infusion clinic and exceeds patients' expectations for obtaining needed medications and therapies.
- Works with insurance carriers to determine patient's eligibility and benefits for high cost pharmaceuticals though medical coverage or pharmacy benefit depending on patient's plan. Performs benefit verifications and pre-authorization requirement to obtain medications and/or prior authorization for patients.
- Works with patient's specialty pharmacy to obtain medications if patient's plan so requires. Researches patient chart to obtain and document medical necessity working with prescribing physician when needed to obtain prior authorization. Prepare letters of medical necessity drafts for prescribing physician as needed.
- Reviews and analyzes all required demographic, insurance/financial, and clinical data procured by patient intake and registration areas necessary to obtain high dollar medications while maximizing reimbursement for those drugs and therapies. Resolves all issues including obtaining information and signatures on documents required by the patient's insurance carrier. Interacts, via telephone and in person, with patients, their representatives, physicians, physician's office staff, employers, and others, and reviews new and previously recorded patient, insurance and procedural information. Electronically records all phone interactions and records resolution to follow-up items in a timely manner. Follows HIPAA, payer, and applicable regulations and standards.
- Acts as a liaison between patients, physicians, and insurance companies to pre-authorize all medication therapies per insurance contract requirements. Notifies patients, physicians and ancillary departments regarding therapies that are potentially not covered and recommends enrollment into patient assistance plans when applicable.
- Assists with clinic workflow and improves patient care by collaborating with specialty nurses to prevent interruptions or delays in treatment due to insurance issues.
- Researches denials including missing authorization, pre-determination or referral documentation. Works on denied accounts by assisting with appeals submissions. Identifies, researches, and secures authorization for unspecified, new or unlisted medications or treatments to procure payment from insurance carriers.
- Utilizes EPIC Scheduling reports, reviewing specified physician ordered tests/ procedures/medications, ensuring the integrity of registration and CPT codes.
- Serves as a team representative at NCH MG Specialty meetings and provides input and recommendations on documentation issues with the patient's need as priority. Researches and analyzes case problems and participates in quality and process improvement initiatives as appropriate. Provides feedback into insurance carrier trends for specialty medication prescribing and authorization requirements.
- Adheres to all Northwest Community Hospital standards, policies, and procedures and reports compliance concerns to management staff.
- High School Required And
- Bachelors Degree Health Administration Required
- 1 Year experience working with specialty pharmacies and insurance companies to obtain medications and prior authorizations. And
- 2 Years previous healthcare or related experience and familiarity with payer requirements, regulatory compliance requirements, HIPAA privacy and security requirements, medical terminology and general revenue cycle procedures required. Prior pharmacy experience preferred.
- Ability to functionally navigate multiple computer software systems with accurate keyboard skills following computer security protocols.
- The interpersonal communication skills necessary to interview and interact with customers, physicians and insurance carriers, to project a professional and compassionate concierge style of service.
- Ability to work independently, exercising good judgment, and multi-task in a high stress, fast paced service environment with patients, physicians and insurance carriers.
- Detail oriented with good analytical problem-solving skills to appropriately register patients and schedule patient procedures.
- Ability to operate routine office equipment (facsimile, copiers, plate production, scanners, printers).
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, and Vision options, including Domestic Partner Coverage
- Tuition Reimbursement
- Free Parking at designated locations
- Wellness Program Savings Plan
- Health Savings Account Options
- Retirement Options with Company Match
- Paid Time Off and Holiday Pay
- Community Involvement Opportunities
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full or Part Time
Required Education
High School or Equivalent
Required Experience
1+ years
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