Insurance Coordinator
Ameripharma
- Orange, CA
- Permanent
- Full-time
- Great pay and general compensation structures
- Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
- Employee assistance program to assist with mental health, legal questions, financial counseling etc.
- 401k program
- Comprehensive PTO and sick leave options available
- Plenty of opportunities for growth and advancement
- Company sponsored outings and team-building events.
- Company sports and recreation leagues to keep you active and get to know everyone better
- Casual Fridays
- Screens and prioritizes orders that require benefits investigation and medical prior authorization.
- Reviews completeness of payers documented in each patient’s insurance profile.
- Identifies patient’s primary, secondary, tertiary, or supplemental plans and authorizing group.
- Reviews accuracy of insurance set up, plan and payer categories.
- Calls insurances to verify specific details on insurance plan coverage and meticulously documents the
procedure codes, deductibles, plan coverage, current level of coverage, maximum out-of-pocket
spending, plan exclusions and limitations, coverage based on place of service, authorization
requirement, claims billing address, claims risk, third party processors, in/out of network coverage and
other applicable billing details. * Documents all communications with insurance plans including the name of insurance representative,telephone, and call reference number. * Identifies and communicates with patients, prescribers and team members plan exclusions andrestrictions, inadequate reimbursement rates and non-covered services. * Executes necessary and applicable financial documents such as the Financial Obligation Notificationand Medicare Advance Beneficiary Notification (ABN) and takes an active role in helping patients
obtain and understand their medical benefits. * Identifies and informs providers and patients of network providers and Ameripharma’s networkparticipation status. * Records all financial discussions with patients and prescribers in patient’s file.
- Identifies, facilitates and coordinates patients’ enrollment to medical drug copay programs.
- Coordinates review of orders or cases that require clinical judgment with a clinical staff.
- Submits prior authorization request to medical plans.
- Informs providers of medical authorization status and payer decision on their requests per department
- Identifies changes in patient’s medical plan coverage and coordinates/reviews new plan payer
update payer assigned to orders accordingly to ensure accurate and proper medical claim submission. * Assists with the resolution of escalated member or provider inquiries related to medical priorauthorization and benefits coverage. * Serves as subject matter expert for internal departments to promote an understanding of benefitsinvestigations and medical prior authorization requirements and processes. * Creates and utilizes reminders and follow up reports to ensure completion of any incomplete orpending activities * Generates reports to keep track of ongoing patients’ monthly eligibility verifications.
- Generates reports to keep track of Expiring Medical Authorizations and initiates submission of
- Runs pharmacy test claims to determine current level of patient’s prescription plan coverage as
- Provides the highest level of customer service in answering patient phone calls and communicating
- Ensures compliance with all company policies and procedures.
- Other duties as assigned
- Ability to read, write, speak, and understand the English language
- Collaborate and cooperate with other team members and management for all Pharmacy needs
- Excellent time management, communication, interpersonal, multi-tasking and prioritization skills
- Strong interpersonal skills
- Ability to support colleagues in a fast-changing environment, collaborative, service oriented, social
- Ability to type with minimal errors
- Ability to read, comprehend, analyze, and interpret data
- Ability to apply common sense understanding and principles of logical thinking to a wide range of
- High School Diploma
- Experience as a medical coder/biller with a working knowledge of managed care, commercial
- Knowledge of automated billing systems.
- Advanced knowledge of Word, Excel, and Outlook functions.
- Microsoft Office/Excel: 1 year
- Pharmacy: 1 year
- Experience with CPR+ preferred
- In-Person (Orange ,Ca)