Intake Referral Representative

2 weeks ago

King of Prussia, United States Penn Medicine Full time

**Description**

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

- The primary functions of this position are to coordinate intake and admission activities for patient referrals and communicate information to internal and external customers for admissions processing; Obtain initial prior authorization for services; obtain ongoing prior authorizations for a selected part of Penn Home Infusion Therapy census as assigned. Duties include (but are not limited to) patient registration, insurance verification, benefits' checks, providing insurance coverage information to patients, families, and to referral sources; real-time documentation in Penn's EMR, real-time communication among patients, referral sources, and PHIT clinicians, completion of required insurance & home infusion documents, incorporating new and changing insurance processes into daily practice, and consistently implementing the prescribed Authorization Tracking process for all assigned patients.

**Responsibilities**:

- Maintains updated knowledge of third-party requirements and guidelines.
- Financially qualifies each referral or restart for servicing through advanced knowledge of reimbursement methodology and procedures, and Medicare requirements prior to acceptance on service.
- Negotiates pricing, as required, with payers, case managers and agents according to established guidelines.
- Advises supervisors and obtains approval prior to acceptance, for pricing requests below established guidelines and/or charity care.
- Develops, collects and distributes required admission forms for signature by the patient within established time frame.
- Maintains updated knowledge of the CPR+ System.
- Exhibits proficiency in all areas of the CPR+ Admission System, including but not limited to: entry of patient personal data, selection and entry of appropriate insurance companies, management of payer master. file, support of patient medical history file, and price matrix development and editing.
- Troubleshoots and corrects problems associated with price matrix file maintenance.
- Actively participates in group training sessions and requests personal assistance in areas of weakness.
- Assists patients with questions regarding insurance matters.
- Displays proficiency in explaining co-pay, deductible and financial obligation to patients.
- Utilizes appropriate judgment in resolving issues surrounding limited financial resources, non-covered therapies and charity requests.
- Supports Ongoing Patient Qualification ProcessReviews and interprets Medicare, Medicaid and third-party payer guidelines to determine appropriateness of diagnosis and related therapy(ies) for reimbursement. purposes, prior to acceptance on service as needed.
- Investigates alternative payment sources for reimbursement of anticipated costs to be incurred by patients determined to have no coverage.
- Researches and investigates all potential avenues of reimbursement for all patients, prior presenting to supervisors for rejection of service.
- Re-verifies patient insurance status and financial obligation on a quarterly basis, and as requested by Supervisor and/or billing department.
- Clearly documents detailed information regarding therapy, diagnosis and method of administration to support accurate and timely reimbursement of charges for each patient serviced.

Credentials:
Education or Equivalent Experience:

- H.S. Diploma/GED (required)
- Education Specialization: Associate of Arts or Science
- Equivalent Experience: 2+ years of experience in a related field such as Billing, AR, Insurance Verification, Pharmacy Technician, or Home Infusion.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

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