Job DescriptionThe Home Infusion Intake Coordinator is responsible for insurance verification, conducting and completing necessary third party (insurance) prior authorization requests, patient out of pocket estimates, patient notification of co-insurance, co-payments and deductible for all treatment plans, patient enrollment in all applicable co-pay programs, foundations and free drug programs to assist with out of pocket expenses, referral for Medicaid/charity care assistance when applicable, billing to co-pay programs and foundations, and co-pay program credit card processing for all patients in our Mount Sinai Home Infusion program. Interacts with hospital employees on multiple levels, including pharmacists, medical/clinical staff, fiscal personnel, department managers, access services staff, coding staff and billing assistants.Responsibilities
- Verifies patient demographic and insurance information and updates all requires systems to ensure all have correct information.
- Completes third party prior authorization requests and verifies prescriptions
- Using an Estimator tool, calculate estimate for out of pocket expenses for treatment plan based on their current insurance benefits and hospital contracts.
- Based on out of pocket expenses, determine if patient is eligible for any drug Co-pay Assistance Programs, foundations or if best option for the patient is a referral to the Medicaid Application team for possible charity care enrollment.
- Clearly communicate to the patient their financial obligations and work with patient to get them enrolled in any/all relevant assistance programs, ensuring the patient understands the programs and their financial responsibility with and without program assistance. Answer any questions the patient might have.
- Maintains contact with prospective patients who may need continued assurances and encouragement to engage in treatment.
- Document patient program enrollment and effective dates in all applicable systems and spreadsheets. Update patient scheduled appointments with the appropriate Co-pay Program financial class.
- Notify clinical team, scheduling team, and patient of any delays in financial clearance issues which might delay their treatment start date.
- Submit claims with attachments and required claim forms when required, to Co-pay Assistance programs or foundations for patient co-pay, deductibles and co-ins. This will require downloading claims explanation of benefit documents from all relevant payer web sites.
- Follow-up with third party groups to ensure Patient Assistance Program claims are received and processed.
- Answer all patient, third party and other department email and/or phone requests regarding billing issues or program enrollment issues.
- Assist in the coordination of onboarding process, including but not limited to: ensuring complete order from provider; scheduling of nursing visit; coordinating pharmacy medication management/340B qualifying visit
- Utilizes Epic and Mount Sinai Home Infusion's electronic medical record to document financial clearance status and patient responsibility.
- Processes cash deposits and addresses mail received related to authorizations and billing
- Cross-trained to support all service lines, treatments, and payers.
- Remains up to date on all new drugs and financial assistance programs they offer.
- Keeps abreast of coverage updates to on all foundation programs and which programs have available funding for a covered diagnosis.
- Schedule is varied to meet the needs of the service sites and ancillary departments.
- Special projects as assigned by supervisor or manager
Qualifications
- High School Diploma ? Associate Degree or higher preferred
- Minimum Related Experience
- 3+ years of prior insurance verification or precertification experience.
- 3+ years of home infusion experience preferred.
- Minimum Computer Skills
- Working knowledge of Microsoft Word, Excel, Internet and Outlook; typing skills with a minimum of 35 words per minute; knowledge of home infusion applications preferred.
- Individual must have the ability to set priorities, problem solves and use proper judgment in difficult situations and be flexible.
Excellent written, oral communication, interpersonal and customer service skills required. Individual must be able to work independently and self-starter.Non-Bargaining Unit, LAI - HSO Pharmacy Home Infusion- STL, Mount Sinai St. Luke'sAbout Us
Strength Through Diversity The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:
- Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.
- Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.
- Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.
At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally. Explore more about this opportunity and how you can help us write a new chapter in our history!
About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high Honor Roll status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's Best Children's Hospitals ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's The World's Best Smart Hospitals ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.
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