Employment Type:

Full time

Shift:

Day Shift

Description:

Saint Francis Hospital and Medical Center and member of Trinity Health of New England is looking for an Authorization and Reimbursement Coordinator to join our team in the Mandell Multiple Sclerosis Center. Our vision is to provide state-of-the-art healthcare to those within our local communities, creating a positive impact for each individual that walks through our doors.

Position Purpose

The Authorization and Reimbursement Coordinator is responsible for ensuring appropriate and accurate submission of insurance prior authorization requests for outpatient hospital infusion services.  Attention to detail and excellent writing skills are required to follow-up and track prior authorization responses. Additional business responsibilities to include oversight of the denials and write offs related to infusion services to ensure timely follow up with pending claims.  Serves as a resource to other Mandell MS Center team members concerning patient insurance plans or billing questions.

What you will do 

• Interpret insurance coverage, understand outpatient hospital insurance benefits and review clinical documentation for prior authorization submissions

• Provide support to patients with questions regarding infusion costs, sponsored assistance programs and potential balances to be incurred with high-dollar infusions that are rendered

• Provide support to patients related to step therapy criteria prior to initiating infusion therapy and educates patients on the process to initiate services

• Communicate to registration, billing and case management concerning billing when necessary

• Communicate with insurance carriers, as well as patients via phone or written correspondence

• Prepare authorization requests for patients being infused at outside infusion Sites

• Review medical records to submit appropriate medical information for review as part of the authorization process

• Identify trends as it relates to authorization approvals, denials, and/or payment and assist with action planning with management team

Minimum Qualifications 

• High School diploma or equivalent; Bachelors Degree in Business Administration or related field preferred

• Five or more years of experience in a health care environment with exposure to the benefit verification process demonstrating progressive responsibilities

• Experience with obtaining/authorizing services with various insurance companies preferred and experience with insurance benefits and pharmaceutical assistance programs for high dollar infusion services preferred

• Attention to detail and excellent writing skills are required to follow-up and track prior authorization responses

Position Highlights and Benefits

• Full time 40hrs M-F days

• Excellent benefits - starting day 1!

 

Ministry/Facility Information

At Trinity Health Of New England, we offer specialized care for multiple sclerosis (MS) through the Joyce D. and Andrew J. Mandell Center for Comprehensive Multiple Sclerosis Care and Neuroscience Research. Our dedicated team at the Mandell Center provides the focused care and supportive services a patient needs to live their best life.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.