Patient Referral Coordinator
4 months ago
Syracuse
Job Description INTRODUCTION Company Overview: This position is available with Upstate HomeCare, a BioMatrix company. BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At BioMatrix the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. Schedule: Monday Through Friday From 8:30am Eastern Standard Time To 5pm Eastern Standard Time Work schedule is subject to change based on business needs. Location: Upon successful completion of on-site training, it is anticipated that an incumbent in this role will work in a hybrid capacity from our location in Syracuse, NY on-site three (3) days per week while working from home two (2) days per week. Work location is subject to change based on business needs. Join our team, bring your best, and receive a $300 retention bonus as our way of saying thanks for being part of our success. Job Description: The Patient Referral Coordinator is responsible for the processing and coordination of all new referrals with the main objective being to clear all patients prior to service in order to ensure proper payment in compliance within all legal and regulatory parameters. This person will ensure accurate, efficient and timely processing of new referrals for Infusion and Enteral services to include, but not be limited to, obtaining all necessary supporting documentation, confirming insurance coverage, coding and pricing of products, documenting patient in applicable computer system, submitting for pre-authorization and coordinating of initial “pushing” of the referral. The Admissions Representative provides support and works collaboratively with referral sources, hospital liaisons, the pharmacy, nursing, and billing and branch personnel. QUALIFICATION REQUIREMENTS • Associate’s degree in Business, Health Care Services, or Medical Sales required, • Minimum of one (1) year of experience in healthcare industry required, • Strong working knowledge of first- and third-party payer requirements as it pertains to the billing and collection industry, • Excellent management, communication, interpersonal, team-orientation, organizational and analytical skills, • Prioritization and multi-tasking skills, • Proficiency with problem resolution, • Self-motivated and self-disciplined, • Computer aptitude, • Minimum of two (2) years of experience with a home care company preferred, • Provide knowledge and leadership regarding infusion intake processes by:, • Receiving new requests for services via phone, fax or other means, • Obtaining all information necessary to accurately process the referral according to established procedures, • Completing referral process within time frame required to meet the needs of the patient, family and referral source, • Accurately completing the patient record in applicable computer system to include all required demographics, insurance and clinical information; recording appropriate progress notes and alerts to present a clear concise picture of patient data, • Confirming insurance coverage for services requested; gathering detailed information regarding, but not limited to, eligibility, deductible, out of pocket, authorization requirements and patient obligations, • Communicating with referral source or liaison regarding, but not limited to, insurance coverage, information limitations and status of referral, • Obtaining insurance authorization when necessary; entering and documenting authorization according to established procedure; tracking authorizations due to expire and obtaining renewals as needed, • Assuring accurate and complete billing information is obtained and recorded to allow for timely claim submission and payment, thus reducing accounts receivable days outstanding, • Communicating any financial obligations to the patient or his/her designee; assuring their understanding and agreement to pay; establishing a payment method up-front, i.e. credit card, • Maintaining the pending referral log on a daily basis; attending rounds each morning prepared to discuss status of each patient, • Responding to requests for assistance from pharmacy billing and clinical personnel, • Remaining familiar with specific payer guidelines, requirements and contracts, • Staying current and implementing industry changes, • Consulting with the Admissions Director or Admissions Manager when faced with unfamiliar situations and when decisions outside of the Intake Representative’s scope need to be made, • Assisting with special projects and perform other duties at the discretion of the Admissions Director or Admissions Manager, • Maintaining monthly Referral Census Log, • Serving as a company resource with regards to Infusion processing and reimbursement, • Demonstrating a professional, cooperative and friendly attitude toward all internal and external customers and co-workers; demonstrating excellent customer service skills, • Using discretion in handling confidential matters, • Adhere to departmental/company policies and procedures by:, • Adhering to policies and procedures, • Adhering to regulations set forth by Medicare and Medicaid, • Adhering to regulations set forth by insurance carriers, • Adhering to regulations set forth in established company contracts, • Exhibits exceptional work ethics by:, • Not being wasteful or abusing branch/company resources (vehicles, building, equipment, supplies, phone, utilities time at work, time absent from work, etc.), • Presenting fair and honest reports of expense, • Following through timely on commitments, • Returning phone calls and e-mails promptly, • Being flexible and having the ability to prioritize, • Allowing others to speak without interruption, • Using proper grammar, a respectful tone and language free of prejudice, harassment, profanity or ill will connotations Communication Skills • Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings., • This position requires constant sitting with occasional walking, standing, kneeling or stooping., • This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms., • This position requires constant talking and hearing., • Specific vision abilities required by this job include close vision and the ability to adjust focus., • This position must occasionally lift and/or move up to 20 pounds, • Required to move/lift physical hardware. PHYSICAL DEMANDS 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. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at or 954.385.7322 x 1425. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. OTHER • Will participate in legal and ethical compliance training each year., • Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures., • Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual., • Will not participate in any conduct considered to be unethical or illegal. EXPECTATION FOR ALL EMPLOYEES Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins. GENERAL INFORMATION: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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