Insurance Coordinator

3 weeks ago

Orange, United States AmeriPharma Full time

**Mission Statement**

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that **We Care**

AmeriPharma is a rapidly growing company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

At AmeriPharma, you'll have access to:

- Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
- Great pay and general compensation structures
- Employee assistance program to assist with mental health, legal questions, financial counseling etc.
- Comprehensive PTO and sick leave options
- 401k program
- Plenty of opportunities for growth and advancement
- Company sponsored outings and team-building events
- Casual Fridays

**Job Summary**

As an Insurance Coordinator at AmeriPharma, you will be responsible for accurate and timely verifications of patients’ medical insurance coverage and securing medical prior authorization to allow for appropriate and prompt payment of services.

**Duties and Responsibilities**
- Screens and prioritizes orders that require benefits investigation and medical prior authorization
- Reviews completeness of payers documented in each patient’s insurance profile
- Identifies patient’s primary, secondary, tertiary, or supplemental plans and authorizing group
- Reviews accuracy of insurance set up, plan and payer categories
- Calls insurances to verify specific details on insurance plan coverage and meticulously documents the
following information; Date of verification, name of insurance, plan type, plan effective date, covered
procedure codes, deductibles, plan coverage, current level of coverage, maximum out-of-pocket
spending, plan exclusions and limitations, coverage based on place of service, authorization
requirement, claims billing address, claims risk, third party processors, in/out of network coverage and
other applicable billing details
- Documents all communications with insurance plans including the name of insurance representative,
telephone, and call reference number
- Identifies and communicates with patients, prescribers and team members plan exclusions and
restrictions, inadequate reimbursement rates and non-covered services
- Executes necessary and applicable financial documents such as the Financial Obligation Notification
and Medicare Advance Beneficiary Notification (ABN) and takes an active role in helping patients
obtain and understand their medical benefits
- Identifies and informs providers and patients of network providers and Ameripharma’s network
participation status
- Records all financial discussions with patients and prescribers in patient’s file
- Identifies, facilitates and coordinates patients’ enrollment to medical drug copay programs
- Coordinates review of orders or cases that require clinical judgment with a clinical staff
- Submits prior authorization request to medical plans
- Informs providers of medical authorization status and payer decision on their requests per department
procedure
- Obtains and communicates directly with providers any necessary clinical information or medical
records needed to appeal a denied or pending authorization request
- Answers medical authorization inbound calls from patients, providers, and other departments
- Identifies changes in patient’s medical plan coverage and coordinates/reviews new plan payer
information with Billers ensuring continuation of service and adequate reimbursement coverage and
update payer assigned to orders accordingly to ensure accurate and proper medical claim submission
- Assists with the resolution of escalated member or provider inquiries related to medical prior
authorization and benefits coverage
investigations and medical prior authorization requirements and processes
- Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or
pending activities
- Generates reports to keep track of ongoing patients’ monthly eligibility verifications
- Generates reports to keep track of Expiring Medical Authorizations and initiates submission of
reauthorization requests ensuring continuity of patient’s drug therapy without any delays
- Documents detailed medical authorization status on each patient’s account (new or otherwise)
accurately and in a timely manner
- Escalates to management any unresolved benefits investigation and medical prior authorization issues
after proper resolution attempts have been made
- Maintains a full caseload while meeting or exceeding designated metrics and turn-around timeframes
- Runs pharmacy test claims to determine current level of patient’s prescription plan coverage as
needed
- Makes call

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