Monday- Friday.
The Intake Specialist, Home Infusion Pharmacy reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
This role serves as the point-of-entry for the Home Infusion Pharmacy department.
Responsibilities:
- Engages in front-end utilization management and per-protocol onboarding procedures to ensure a safe, efficient, and accurate intake process for the pharmacy.
- Actively and effectively serves as a remotely functioning liaison for the home infusion pharmacy to case managers, social workers, physicians, and other referring partners.
- Monitor and respond to requests for Home Infusion Pharmacy services in an efficient, accurate, and professional manner via several platforms such as email, phone, and Allscripts/Careport, to name a few.
- Exercise autonomy when scrutinizing prospective referrals for acceptance. Navigate and leverage tools to make informed decisions about referral acceptance and denial. Maintain and update reference tools, as appropriate.
- Conduct eligibility verification, benefits investigation, test claims (when applicable), and prior authorizations for all cases related to Home Infusion Pharmacy. Assist in the coordination of appeals for prior authorization denials, when indicated. Must have ability to navigate and execute functions within health insurance electronic portals and/or communicate with payor representatives via telephone.
- Actively communicate with members of the care management team, patient care team, and pharmacy to provide status updates on referrals. Communication mode (email, phone, progress note, warm hand-off, etc.) may vary depending on the audience and situation.
- Work with Pharmacy software (CPR+) to create patient profiles and document communication notes in order to keep the Pharmacy team abreast of new information.
- Provide accurate information and timely updates to patients and customers. Addresses questions and concerns promptly, or identifies appropriate person and resources to do so.
- Participates in efforts to reduce costs, streamline work processes, improve and grow services provided.
- Utilizes department and hospital policies and procedures to complete assigned tasks.
- Demonstrates knowledge and compliance with insurance, local, state and federal regulations related to physician and hospital billing. Has a firm understanding of those home infusion services covered by commercial and federal payers.
- Participate in team meetings, quality improvement initiatives, and other activities as requested.
- Assist with the onboarding and training of new members of the team.
- Other responsibilities as assigned and indicated