Infusion Prior Authorization Coordinator at Carolina Health Specialists – Myrtle Beach, South Carolina

INFUSION PRIOR AUTHORIZATION COORDINATOR needed for busy medical practice in Myrtle Beach. Must have excellent computer and customer service skills. Hours are Mon.-Thurs. 7:45am-5:15pm & Fri. 8:00am-12:00pm. No nights or weekends! Excellent pay and benefits including paid holidays, PTO and sick time, medical, dental, vision, short and long-term disability, employee assistance program, company paid life insurance, pre-paid legal, identity theft, and 401k offered.

JOB TITLE: Infusion Insurance Verification Coordinator

GENERAL SUMMARY OF DUTIES: Responsible for verification of insurance benefits and obtaining pre-certifications and authorizations on all Infusions.

SUPERVISION RECEIVED: Office Manager

ESSENTIAL FUNCTIONS:

1. Processes insurance verification in a timely manner.

1. Prepares insurance forms and associated correspondence as needed.

1. Coordinate patient assistance and co-pay programs

1. Make patients aware of their financial responsibility after insurance benefits have been determined.

1. Follow up on claims to ensure that insurance companies have paid according to agreement and as verified.

1. Maintains strict confidentiality required related to medical records and other data.

1. Schedule all infusion referrals.

1. Maintains files with insurance authorizations and referrals.

1. Obtains prior authorizations for all infusions, injections, and drugs needed for infusion.

1. Handles appeals for denied Prior Authorizations.

1. Adds new patients to the Lynx system.

The job holder must demonstrate current competencies applicable to the job position.

EDUCATION: High school graduation or GED. Associate degree in business administration or secretarial program preferred.

EXPERIENCE: Minimum of three years’ experience with handling insurance verification and obtaining information on patients’ insurance benefits.

REQUIREMENTS: None.

KNOWLEDGE:

1. Knowledge of clinic policies and procedures.

2. Knowledge of medical terminology and insurance practices.

3. Knowledge of computer programs and applications.

4. Knowledge of grammar, spelling and punctuation to type correspondence.

SKILLS:

1. Skill in gathering, interpreting and reporting insurance information.

2. Skill in trouble-shooting insurance problems and claims.

3. Skill in written and verbal communication.

ABILITIES:

1. Ability to identify claim problems and recommend solutions.

2. Ability to sort and file insurance forms and associated information.

3. Ability to work effectively with patients, employees, providers and the public.

PHYSICAL/MENTAL DEMANDS: Work requires hand dexterity for office machine operation, stooping and bending to files and supplies, mobility to complete errands, or sitting for extended periods of time.

ENVIRONMENTAL/WORKING CONDITIONS: Normal office environment. May view computer screens for long periods of time.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.