Infusion pharmacy Intake/Referral Coordinator

Summary:

The position of Intake Referral Coordinator assists the Admissions Team Lead with services and all issues related to referral processing. The Intake Referral Coordinator is responsible for the accurate and complete processing (benefit verification) of specialty pharmacy and infusion therapy referrals from referral sources.

Education/Experience:

  • High school diploma required.
  • Minimum of 6 months relevant and demonstrated experience in the healthcare industry preferably in specialty infusion preferable.

Certifications and Licenses:

  • CPhT preferred

Duties and Responsibilities include the following. Other duties may be assigned.

  • Ensure that all referrals are complete, clear and within company’s scope of service
  • Verify insurance accurately and completely prior to passing the referral to the pharmacy staff.
  • Gather and exchange information to gain authorization for therapy requested and re-authorization as necessary which may include gathering patient-specific clinical data from referral sources
  • Coordinate with Sales and Advocates in order to facilitate records requests from referral sources.
  • Request and perform timely follow-up on authorizations for medical and pharmacy benefits
  • Calculate gross margins for therapies
  • Enter patient demographic information into the clinical system.
  • Communicate with other departments, including sales, regarding the status of referrals and documentation requests.
  • Notify patients/families/referral sources regarding coverage and payment responsibilities as necessary.
  • Respond to inquiries from patients and referral sources via telephone, fax and electronic data interfaces.
  • Document in the patient's clinical record progress notes, all requests and conversations for the purposes of seamless coordination of care.
  • Demonstrate professional etiquette and courtesy when interfacing with consumers/ customers.
  • Aid in the resolution of consumer/customer complaints by identifying problems and coordinating appropriate corrective action through attention to detail and taking the initiative to resolve issues before they become a problem.
  • Comply with and adheres to all regulatory compliance areas, policies and procedures and company "best practices"
  • Insure that the patient database is complete for height, weight, current and past medical history, clinical laboratory results and concurrent medications (including over-the-counter and/or home remedy medications) as necessary.
  • Assist the pharmacist, nurse and patient with clinical and technical support
  • Work with team of other pharmacists, pharmacy technicians, nurse and sales staff to ensure quality of care to all patients.
  • Performs other functions related to the clinical department as deemed necessary by the AVP of Patient Financial Services.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Language Ability:

Ability to read, analyze, and interpret admissions process procedures. general business periodicals, professional journals, technical procedures. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Math Ability:

Ability to comprehend and apply principles of basic math while analyzing data and generating reports.

Reasoning Ability:

Ability to apply principles of logical thinking and decision making to a wide range of intellectual and practical problems while under stress and respond quickly and accurately.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Microsoft products.

Information Security Expectations:

While performing the duties of this job, the employee is required to abide by Diplomat's information security policies, employee handbook and security and privacy regulatory requirements. Each employee is responsible for the secure and appropriate handling of company information, information received by customers, other companies and/or external parties.

Knowledge, Skills and Other Abilities:

  • Time management
  • Oral and written communication skills
  • Professionalism
  • Communication skills * Organization
  • Customer Service
  • Detailed
  • Multi-tasking skills
  • Ability to work well with various personalities and within a team
  • Medical terminology
  • Medical insurance
  • Participate in continuous quality improvement activities

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to walk; sit and use hands. The employee is occasionally required to stand.

Job Type: Full-time

Experience:

  • relevant: 1 year (Preferred)
  • Referral Coordinator: 1 year (Preferred)

Education:

  • High school or equivalent (Preferred)

Work Location:

  • One location

Benefits:

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Retirement plan
  • Paid time off

This Job Is Ideal for Someone Who Is:

  • Dependable -- more reliable than spontaneous
  • People-oriented -- enjoys interacting with people and working on group projects
  • Detail-oriented -- would rather focus on the details of work than the bigger picture

This Company Describes Its Culture as:

  • Stable -- traditional, stable, strong processes
  • Team-oriented -- cooperative and collaborative

Schedule:

  • Monday to Friday