Providence Health & Services Insurance Benefit and Authorization Specialist - Home Infusion in Spokane, Washington
Providence is calling an Insurance Benefit and Authorization Specialist - Home Infusion (East Hospital Admin G And A, Day Shift, 1.0 FTE) to Providence Infusion and Pharmacy Services in Spokane, Washington. We are a community of caregivers delivering every day on our Mission to provide compassionate care that is accessible for all - especially those who are poor and vulnerable.
In this position you will:
Verify insurance benefits and eligibility on all new referrals.
Perform monthly verification of DSHS coverage for long term Medicaid patients and weekly verification for capitated Hospice patients.
Assist in evaluation of documentation to determine if patient meets criteria for coverage of therapy.
Gather necessary information to assure accuracy and completeness of forms and reports; Work with management and staff to correct omissions, errors, office systems problems, etc.
Responsible for creating Cost Disclosure/Advance beneficiary notices for Medicare patients and tracking for signed form.
Responsible for generating benefits letter to inform patient/responsible party of financial responsibility and sending to patient.
Responsible for entering new patient and physician date into the software database, including new therapy sessions on existing patients; Enter ICD-9/ICD-10 codes as needed.
Obtain PCP referral request and follow-up.
Document appropriately in patient electronic record regarding payer/billing information.
Obtain initial pre-authorizations as required by insurance plans.
Verification of physician licensure on an ongoing basis.
Support and incorporate Sisters of Providence Health System Mission into daily activities.
Participate in QA/QI.
Perform Medicare Part D eligibility and drug formulary checks.
Prepare hospital charity agreements and send and track patient financial assistance applications.
Required qualifications for this position include:
High school diploma or equivalent
One (1) year experience in medical office setting
General computer knowledge and skills, including word processing, spreadsheets and database software
Knowledge of medical terminology
Preferred qualifications for this position include:
Medical Reimbursement experience
Verification of insurance benefits experience and authorization experience
Knowledge of Medicare/Medicaid/commercial payors
About the ministry you will serve.
Providence Infusion and Pharmacy Services in Spokane, Washington provides home and ambulatory infusion services to pediatric and adult patients in Washington, Idaho, Montana, and Oregon. Patient quality/safety, satisfaction, and positive clinical outcomes are top priorities. Our services include infusion therapy and enteral/parenteral services to patients in their homes or in our Ambulatory Infusion Suites (AIS), disease management, specialized infusion services, and clinical nurse, pharmacist, and dietitian consulting and support. Spokane is in the heart of the Inland Northwest, offering four seasons of winter snow, cool springs, warm summers, and mild fall temperatures. Outdoor recreational activities are numerous including fishing, hiking, biking, camping, skiing, hunting, golfing, and boating. Spokane is located about 30 miles from Idaho and is within a few hour drive of Seattle, Portland, Missoula, Canada, and the coasts of Washington and Oregon. Spokane is a vibrant community that is easy to navigate with short commute times and offers of a variety of sporting events, concerts, shopping, dining, and entertainment experiences.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Pharmacy Technician
Req ID: 254816