Home Infusion Intake Specialist

Home Infusion Intake Specialist

Bring your passion to Texas Health so we are Better + Together

Work location: Texas Health Medical Support 1100 Bridgewood Street TX 76112

Work hours: Full time (40hours) Day shift

This position will be responsible for receiving and processing new referrals for home infusion services. These duties will include benefits verification, financial payment planning, co-pay and deductible calculations, receiving patient payments, troubleshooting claim rejections, obtaining prior authorizations and supporting both Professional Billing and Pharmacy staff in their duties.

Here's What You Need

Education

• High School Diploma or Equivalent Required And

• Associate's Degree Business / Communication Preferred

Experience

• 2 Years Insurance verification, benefits, and eligibility investigations required and

• 1 Year Experience in specialty, home infusion or hospital pharmacy preferred

What You Will Do

Receipt of Referral

Referrals may be received through the Outpatient Referral pathway in EPIC or via fax from a non-THR provider.

Referrals will be triaged and routed to the correct work queue in EPIC for further work-up.

If a referral needs to be reviewed by a clinician, the intake personnel will make that determination and route the referral to the appropriate person.

1. Verification of patient benefits and submission for authorization when required.

Intake staff will verify patient benefits by accessing payor portal.

Status of deductibles and any co-pays will be ascertained and added to the financial worksheet.

Any prior authorization will be completed at this step.

1. Adjudication of order

Medication orders will be adjudicated based on the NDC number of the product. NDCs are reimbursed at different rates. The final determination of which NDC to use will be based on the adjudication results and in conjunction with a pharmacist.

1. Financial benefits investigation and counseling

Insured patients will go through a full benefits investigation with the goal being to produce a financial statement for the patient that outlines their total financial responsibility.

Uninsured patients will have a financial review with an FPI number being generated from this review.

Patients that qualify for charity will be tracked and the discharging facility will be billed separately.

Patients that do not qualify for charity will be marked as Self-Pay and a financial agreement will be provided to the patient and must be signed prior to accepting them for service.

1. Contacting and finalizing home health nursing visits

Based on patient location, therapy type, and insurance benefits, home health agencies will be contacted, and home health visits will be set up for the durations of the patients therapy.

1. Managing the assigned work queues in EPIC

Referrals will move into various work queues as tasks are completed. These work queues must be monitored and the required tasks completed in a timely manner in order to move the referral forward through the process.

1. Hand-off of referral to pharmacist

Once all intake tasks have been completed the referral will be moved to the pharmacist work queue.

1. Customer Service and Escalation

Patient and Customer Service Support

Address questions and concerns from patients, caregivers, and referral sources in a timely, empathetic, and professional manner.

Escalate unresolved or complex patient issues which include complaints related to insurance coverage, financial responsibility, or clinical matters and route these patient issues to the appropriate leader or team.

Serve as a liaison to promote transparency, reduce stress for the patient, and enhance trust throughout the intake process.

Document in the patient's clinical record progress notes, all requests and conversations for the purposes of seamless coordination of care.

1. Documentation Standards

Documentation and Systems Use

Accurately document referral information, insurance benefits, authorization status, and patient communication notes in EPIC and all applicable systems. Maintain clear, timely, and compliant documentation to support care coordination and revenue cycle processes.

Additional perks of being a Texas Health

• Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, student Loan forgiveness as well as several other benefits.

• Delivery of high quality of patient care through nursing education, nursing research and innovations in nursing practice.

• Strong Unit Based Council (UBC).

• A supportive, team environment with outstanding opportunities for growth.

Learn (https://jobs.texashealth.org/why-texas-health/) more about our culture, benefits, and recent awards.

Explore our Texas Health careers site (https://jobs.texashealth.org/) for info like Benefits (https://jobs.texashealth.org/benefits) , Job Listings by Category (https://jobs.texashealth.org/professions) , recent Awards (https://jobs.texashealth.org/awards) we've won and more.

Do you still have questions or concerns? Feel free to email your questions to [email protected] .

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Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities.

We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.