Infusion Coordinator in Washington, DC at The GW Medical Faculty Associates.

Date Posted: 8/6/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Penn Street Northeast
    Washington, DC
  • Job Type:
  • Experience:
    5 to 7 years
  • Date Posted:
    8/6/2020

Job Description

Position Summary

To coordinate and monitor authorization activities of the Medicine Department.

Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  Other duties may be assigned.

  • Responsible for the accurate and complete processing of (benefits verification through clearance) of infusion services and referrals from physicians.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
  • Complies with patient confidentiality laws and regulations. Verification of FDA and NCCN guidelines as it relates to coverage of infusion medications.
  • Review and processes the medical necessity for each patient chemotherapy treatment and documentation of regimen and pathway adherence.
  • Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.
  • Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
  • Works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Obtains insurance authorization and pre-certification for chemotherapy services and non-chemo infusions.
  • Act as a liaison with third party carrier professionals regarding infusion reimbursement issues.
  • Assist physicians, staff and the MFA Business Office in the development of mechanisms to challenge claims as necessary.
  • Authorization and documentation in patient’s electronic chart of all data and communication is critical for the purpose of seamless coordination of care
  • Request retro-authorizations as needed for services that were not pre-authorized.
  • Develop and implement departmental policies on managing MFA Business Office correspondence (i.e. account actions related to infusion services.
  • Notify patients/families regarding coverage and payment responsibilities prior to scheduling infusion appointments
  • Obtain benefit authorization and verification team PRIOR to scheduling infusion appointments
  • Coordinates start of care with patient and provide patient with any pre-appointment special instructions
  • Must be knowledgeable about reimbursement issues and which insurance companies have active contracts with Medical Faculty Associates, Inc.
  • Comply with and adheres to all regulatory compliance areas, policies and procedures and company “best practices”
  • Must be knowledgeable of medical terminology, CPT, HCPCS, ICD-10, medical insurance, professional billing requirements and must possess excellent communication skills both verbal and written

Qualifications

Education

  • Associates or Bachelors degree in accounting, business administration or related field, or an equivalent combination of training and experience, is necessary.

Experience

  • 5-7 years of relevant experience in insurance verification and authorization.
  • Reimbursement analysis, and other third party interactions is required.
  • Knowledge of Medicare-Part B (CMS) policy on billing and reimbursement is preferable.