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Insurance Coordinator

2 months ago

Laguna Hills, United States AmeriPharma Full time

About AmeriPharma

AmeriPharma is a rapidly growing healthcare 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.

AmeriPharma's Benefits

  • 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.

Schedule Details
  • In-Person (Laguna Hills, Ca)
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
  • Serves as subject matter expert for internal departments to promote an understanding of benefits
    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 calls to payers to verify member pharmacy eligibility and benefits as needed
  • Provides the highest level of customer service in answering patient phone calls and communicating
    with doctors' offices and their staff
  • Identifies and communicates to the management team any benefits investigations and medical
    authorization process inefficiencies and recommend process improvement
  • Ensures compliance with all payer rules and regulations
  • Ensures compliance with all company policies and procedures
  • Other duties as assigned
Required Skill Qualifications
  • Ability to read, write, speak, and understand the English language
  • Collaborate and cooperate with other team members and management for all Pharmacy needs
  • Excellent time management, communication, interpersonal, multi-tasking and prioritization skills
  • Strong interpersonal skills
  • Ability to support colleagues in a fast-changing environment, collaborative, service oriented, social
    perceptiveness
  • Ability to work independently with minimal guidance
  • Ability to type with minimal errors
  • Ability to read, comprehend, analyze, and interpret data
  • Ability to apply common sense understanding and principles of logical thinking to a wide range of
    intellectual and practical problems and to deal with abstract and concrete variables
  • Ability to work the hours that will ensure all projects and duties are completed in a timely manner
Education Requirements
  • High School Diploma
  • Experience as a medical coder/biller with a working knowledge of managed care, commercial
    insurance, Medicare, and Medicaid reimbursement required.
  • Knowledge of ICD 10, CPT, HCPC and J billing codes and medical terminology, with CMS HCFA 1500
    form & Electronic Billing.
  • Knowledge of Benefit Investigation and Patient Responsibility Agreements.
  • Knowledge of automated billing systems.
  • Advanced knowledge of Word, Excel, and Outlook functions.
Preferred Skills and Experience
  • Microsoft Office/Excel: 1 year
  • 1 year of Pharmacy experience
  • Experience with CPR+


AmeriPharma's 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

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.