Intake Eligibility Representative

Job Description

Job Description

Come join an exciting and innovative company that puts the “care” back in healthcare!

At KabaFusion, our patients come from all walks of life and so do we. We hire GREAT people, period! Our culture celebrates and supports the differences that make us unique. Here, it doesn’t matter what your role is, your hard work and dedication is not only recognized but celebrated. Join us and find out why this is the place to excel and do your best work.

About Us :

What started as a single pharmacy in 2010 has grown into KabaFusion becoming the largest privately held home infusion company in the country. We have a national network of pharmacies and nursing offices strategically placed to service 40+ states. Couple that with over 30 years of combined experience and it’s no wonder why KabaFusion is the industry leader in home infusion.

JOB SUMMARY :

Responsible for the insurance re-verification process of patients and their insurance companies, federal agencies and third-party payers. Communicates and obtains signed start of care documentation from patients, caregivers, responsible parties. Audits patient accounts to ensure accuracy and clean claims. Coordinates receipt of information with internal departments. Shows concern and respect for others by dealing with people in a compassionate, sensitive and responsive manner. Performs a variety of tasks under general supervision. A certain degree of creativity and latitude is required. Additional dimensions may include working with operating budget, revenue responsibility, purchasing responsibility, etc. Ensures company’s goals and objectives are aligned with the organization’s broader mission, vision, and driving strategies.

MAJOR DUTIES AND RESPONSIBILITIES :

1. Answers telephone utilizing appropriate etiquette and speaks with general public, referral sources, payors, clinician's patients and their families.

2. Verifies insurance coverage on a monthly basis prior to deliveries to ensure active coverage is in place. Notifies internal departments and patients of any and all changes in policies, or benefit termination.

3. Confirms that services to be provided by company are a covered benefit under patient's insurance coverage.

4. Completes start of care paperwork, Financial Obligation Form, Medicare / Medicaid forms as needed. Forwards the necessary paperwork to Pharmacy department for delivery, or via mail (electronic or postal).

5. Obtains and documents in the system all information related to coinsurance, copay, deductibles, authorization requirements, etc.

6. Determines estimated patient financial responsibility using insurance verification information and payer contracts and / or self-pay guidelines

7. Tracks and obtains patient start of care paperwork to ensure all records are compliant. Creates additional documentation as required to service the patient per policy and payer guidelines.

8. Acts a liaison between reimbursement and Central Intake and Reauthorization Department when necessary for complex case resolution.

9. Must be able to prioritize, multi-task, meet goals and deadlines and communicate effectively with patients, clinical corporate departments.

10. Protects patient health information by following regulations for HIPAA compliance

11. Other duties as assigned.

EDUCATION AND / OR EXPERIENCE :

• High School Diploma or equivalent education
• Candidate must be experienced with a minimum of 2 years of experience in Home Infusion
• Knowledge and understanding of HCPC, CPT Codes
• Candidate must be a self-starter and motivated to research and resolve issues
• Ability to work independently with minimal supervision and prioritize to meet deadlines, as well as ability to work in a collaborative manner
• Strong understanding of Medicare, Medicaid and insurance coverage criteria, insurance terms, medical terminology, pricing methodologies for commercial and government billing requirements.
• Proven solution-oriented attitude
• Microsoft Word and Excel

What we offer :

To learn more about KabaFusion, please visit our careers page : https : / / www.kabafusion.com / careers /

Join us and find out why this is the place to excel and do your best work.