Chesterfield, MO, United States
Jul 06, 2021
DescriptionnUnder the direction of the Supervisor, the Billing Coordinator is responsible for assisting with the financial operations of the infusion center. This is accomplished through working with physician practices in and outside of St. Lukeu2019s by verifying medical necessity, processing and pre-certifying all infusion patients, including professional and technical charges.n nPrinciple Accountabilities: % of Time Spentn n1. Initiates and completes the insurance and benefits verification for oncology and hematology patients throughout the cancer center as well as all patients sent to the infusion center from outside referring physicians. Ensures that pre-authorizations are obtained per payer regulations and maintains accurate records of authorizations in the EMRu2019s (Mosaic and Cerner). Works closely with physicians to ensure medical necessity is met before scheduling procedures in accordance with centers for Medicare and Medicaid services (CMS) or other payer standards, and communicates coverage and eligibility information to patients. Provides financial estimates to patients. Collects accurate demographic and financial information for patients receiving services in the infusion center. Verifies insurance for scheduled patients within 24 hours of pre-registration, and for non-scheduled patients within 24 hours of registration. Confirms appropriate use of diagnosis codes to comply with payer regulations for prior authorizations. Accurately documents all information in Mosaiq and Cerner to allow for close collaboration and work on failed claims. Work and clear work failed claim queues weekly. Identify pattern and trends to train team members. 55%n n2. Works closely with finance department, insurance verification team and physician practices to expedite prompt and appropriate resolution of patient accounts. Coordinates with scheduling and registration in regards to insurance and authorization issues. Reports on activities, issues, and any action items to management and staff. Keeps up to date on all insurance plans policy changes and communicates to staff. 20%n n3. Send patient prescriptions and insurance information to pharmacies. Follow up with pharmacy to ensure patient receives medication and communicates information to the physician. Obtains pre-certification of medication, with close attention to oral agents and applies for patient assistance. Walks patient through the drug patient assistance process including paperwork and coordinates assistance with drug companies. Evaluates patient insurance benefits and counsels patients on financial matters including benefits, financial support, drug assistance and co-pay assistance, and financial assistance. Apply for drug replacement and ensures billing is correct when drug replacement is received. 10%n n4. Schedules patients to be seen in the Infusion Center and print daily schedule for chemotherapy and infusion patients receiving treatment. Communicates closely with Infusion nurses to ensure complete authorization is in place prior to treating. Verify daily master report and print labels for infusion room. Cerner registration and associated reports. Monitor appropriateness of medical necessity of general infusion orders. Process daily infusion orders, scan into Electronic Medical Record and follow up on pre-certification for infusion services. Coordinate with infusion nurses on any issues regarding patients receiving infusions. Coordinates with St. Luke's Hospital's Pre-certification Department to ensure each patient's insurance covers the treatment ordered by the physician. E-mail correspondence between pre-cert department and Medical Records for medical necessity, benefit coverage, and documentation of services. Enter infusion charges. 15% 5. Performs other duties and special projects as needed and requested by manager, nurses and physicians. Total: 100% n nEducationnHigh school or GED required; college preferred.nExperiencenPrevious work experience with insurance verification and precertification in hospital/physician offices or related areas required. Extensive computer skills required. Necessary skills are accuracy, attention to detail and ability to communicate well with physicians, team members, and patients.nExcellent telephone etiquette required.nExcellent documentation skills, ability to multi task and handle high work volume.nPromotes and provides courteous and effective communication with internal and external customers.nWorking ConditionsnEmployee is required to sit frequently, stand and walk occasionally. Employee must lift/carry light (20# max) frequently, and medium (50# max) occasionally. Employee is required to bend, squat, reach forward, reach overhead, and lift from floor to waist occasionally. For repetitive action, employee is required to use one or both hands for simple grasping, pushing/pulling and fine manipulation. Employee is continuously exposed to electrical hazards and CRT terminal work. Job Relationships: Member of a comprehensive healthcare team, including other healthcare providers, the patient, the patient's family and significant others. Takes direction from: Revenue Cycle Supervisor and Cancer Center Assistant Director.Supervised by: Revenue Cycle SupervisorSupervises: N/A nMission/ValuesnMISSION nFaithful to our Episcopal-Presbyterian heritage and its ministry of healing, St. Lukeu2019s is dedicated to improving the health of the communities we serve.nUsing talents and resources responsibly, we provide high quality, safe care with compassion, professional excellence and respect for each other and those we serve.n nVISIONnAs an independent healthcare network, we create healthy communities in the region through our commitment to high quality, safe and personalized services.n nCORE VALUESnHuman DignitynWe accept and treat all persons as being created in the image of God.n nCompassionnWe respond with caring to the needs of others as if they were members of our family.n nJusticenWe honor each personu2019s rights and responsibilities in light of the common good.n nExcellencenWe set and strive to attain high standards of performance and continuous improvement.n nStewardshipnWe use our talents and resources wisely, with honesty and integrity.n nFACES - Friendly - Available - Caring - Efficient - Safe Communication Standards: Promotes and provides courteous and effective communication with internal and external customers.