Intake Coordinator, Pharmacy & Infusion

The Intake Coordinator is responsible for retrieving the referral as defined by each customer; completing an insurance investigation that determines the patient's eligibility and financial responsibility for the proposed therapy within the customers expected time-frame; and relaying the results to the customer in way that allows them to make a decision whether or not the customer should accept the patient onto their service. In addition, this role is responsible for completing the patient registration within Brightree, and initiating any authorizations as required by the payer. Lastly, responsible for other intake related tasks as assigned.

Key Responsibilities

• Understanding all general rules, guidelines for the payers associated to the customers for which they are assigned.
• Responsible for completing the insurance investigations for the assigned Brightree customers(s) by completing the following tasks timely and accurately:
  • Retrieving the new patient (or new therapy) referrals using the methods established with each customer in a timely fashion.
  • Complete the insurance investigation for each payer and each therapy to include:
    • Drug coverage options (NCPDP versus major medical): Is it essential to send NCPDP. If there is an option, what is the impact to overall profits for customer and impact to patient liability. Need to determine if the NDC code(s) being dispensed are covered and what restrictions may occur.
    • Ancillary drugs: Determine if ancillary drugs are included or excluded from coverage.
    • Prophylactic Drugs: Determine coverage for prophylactic drugs on
    • all patients including: Benadryl (diphenhydramine), epinephrine, and Cathflo Activase (in the event of a line block during therapy).
    • Nursing visits: If applicable, are nursing visits covered.
    • Supply coverage: Determine how supplies are billed (per diem or using supply kits). If billing with a per diem, ensure that the standard NHIA codes are acceptable, and if not, determine if the therapy falls under a covered per diem.
    • Equipment: Determine if including in per diem or separately billable.
  • Determine authorization requirements for each segment of each therapy including max quantity, documentation requirements, etc.:
    • Nursing visits
    • Pharmacy/drugs
    • Per diem/supply kits
    • Equipment if applicable
    • ALWAYS get an authorization for cathflo activase
  • Identifying areas of opportunities to better streamline processes
    • System Enhancements to the Brightree System
    • Process improvements to increase efficiency
  • Prepares and submits reports to team lead as needed including but not limited to:
    • Quality Assurance Reporting
    • Total referrals received versus total patients/therapies that started service
    • Service Level Agreement Reporting
  • Ensures adherence to objectives, operating policies and procedures, and strategic action plans for achieving goals
  • Maintains patient confidentiality and function within the guidelines of HIPAA
  • Other tasks and responsibilities as assigned.

Qualifications & Experience

• High school diploma required; equivalent combination of education and experience will be considered
• Minimum of 2 years of home infusion intake, billing or home infusion accounts receivable (collection) experience required
• Minimum of 2 years of experience working in & maintaining HIPAA standards
• Highly skilled in using computers & Microsoft products (Excel and Word) is required
• Highly motivated to research and document the results of each patient referral via on-line and the phone or via software applications
• Math aptitude
• Strong problem-solving skills focused on resolving complex home infusion reimbursement cases
• An effective communicator with strong oral, written and persuasive skills and capability to deal with people at all levels in the organization and the public in a professional manner
• Exceptional organizational skills with a high level of attention to detail and the ability to multitask
• Self-starter, results driven, highly motivated, high energy
• Proven track record of working towards and exceeding metrics strongly preferred

We are shaping the future at ResMed, and we recognize the need to build on and broaden our existing skills and continue to attract and retain the world's best talent. We work hard to offer holistic benefits packages, provide flexible work arrangements, cultivate a workforce culture that allows employees to grow personally and professionally, and deliver competitive salaries to our team members. Employees scheduled to work 30 or more hours per week are eligible for benefits. This position qualifies for the following benefits package: comprehensive medical, vision, dental, and life, AD&D, short-term and long-term disability insurance, sleep care management, Health Savings Account (HSA), Flexible Spending Account (FSA), commuter benefits, 401(k), Employee Stock Purchase Plan (ESPP), Employee Assistance Program (EAP), and tuition assistance. Employees accrue fifteen days Paid Time Off (PTO) in their first year of employment, receive 11 paid holidays plus 3 floating days and are eligible for 14 weeks of primary caregiver or two weeks of secondary caregiver leave when welcoming new family members.

Individual pay decisions are based on a variety of factors, such as the candidate's geographic work location, relevant qualifications, work experience, and skills.

At ResMed, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current base range for this position is: 23.28 - 29.20 USD Hourly.

For remote positions located outside of the US, pay will be determined based the candidate's geographic work location, relevant qualifications, work experience, and skills.

Joining us is more than saying "yes" to making the world a healthier place. It's discovering a career that's challenging, supportive and inspiring. Where a culture driven by excellence helps you not only meet your goals, but also create new ones. We focus on creating a diverse and inclusive culture, encouraging individual expression in the workplace and thrive on the innovative ideas this generates. If this sounds like the workplace for you, apply now! We commit to respond to every applicant.