Infusion and Medication Authorization Coordinator

Summary:

The Infusion Authorization Coordinator (IAC) is responsible for obtaining access to prescribed treatment, authorizations when required, and ensuring all appropriate financial reimbursement of treatment occurs. The Infusion Authorization Coordinator will run benefit investigations, obtain authorizations, communicate potential financial risks and enroll patients in assistance programs to help with the cost of treatment medications. 

Responsibilities include the following. Other duties may be assigned:

· While completing the prior authorization process, the Infusion Authorization Coordinator (IAC) contacts the patient to inform them of any financial costs such as deductible and/or coinsurance exposure before treatment is scheduled and communicates practice payment policies. 

· Works with pharmacy department for medical necessity information.

· Uses practice software and authorization software to obtain patient insurance information and necessary clinical documentation from the requesting provider to use in the benefits investigation and prior authorization (PA) process.

· Completes documentation in patients electronic record of all conversations with the patient and insurance companies.

· Documents authorization information in practice management solution and communicates approvals to infusion staff so scheduling can take place.

· Runs reports for upcoming infusion appointments to conduct benefit investigation prior to each scheduled infusion treatment to determine eligibility and patient financial responsibility. If a prior authorization is necessary for treatment, the IAC is responsible for obtaining the authorization and communicating any issues in obtaining authorization to clinical staff.

· Runs reports for upcoming infusion appointments to identify patients that have expiring authorizations and obtains a new authorization prior to their scheduled treatment appointment.

· Enrolls patients into the Co-Pay assistance programs when eligible and contacts patients prior to their coverage expiration to re-enroll them.

· Demonstrates knowledge of insurances, drug formularies and rheumatology treatment.

· Knowledge of prior authorization, workflows, payer reimbursements, insurance benefits, ICD and CPT codes.

· Obtains free drug for patients that do not have necessary coverage for ordered infusion medications.

· Assists infusion scheduler in ordering the free drug medication.

High school diploma or GED equivalent, plus 2 years relevant experience in infusion authorization or billing, medical insurance and/or medical billing.