Retina Drug Coordinator
We are seeking a Retina Drug Coordinator who will manage all administrative aspects of the patient encounter involving intravitreal injection therapy. This includes accurate data entry on each patient to facilitate the appropriate pre-certification of therapy, expediting the check-in / check-out process, and afford appropriate billing.
Specific Duties & Responsibilities
- Confirms all needed forms are up to date, and signed (Outpatient agreement, consents)
- Obtains pre-certification as required by patient’s healthcare insurer or managed care provider.
- Obtains preauthorization for retina drug injections with following the insurance guidelines process.
- Checks over provider schedules 2 weeks in advance for errors and repeats within 48 hours of date of service for any urgent additions.
- Follows payer guidelines.
- Follows ICD-10 codes to ensure diagnosis codes are appropriate for each retina drug prior to claim submission.
- Follows limiting coverage guidelines for diagnosis coding by using LCD/NCD/payer policy information and assigns appropriate modifiers based on departmental policy.
- Maintains familiarity with various types of insurances. Contacts insurance carriers for clarification of coverages to avoid denials of payment.
- Monitors and responds to assigned work queues.
- Provides support to both East Baltimore and satellite clinics during events of short staffing ( sickness, vacation, meetings)
- Guides patients and families to appropriate resources (financial counselors, international office, social worker, drug copay assistance programs)
- Assists in enrolling patients in drug copay assistance programs and tracking payments.
- Verifies insurance information for each injection scheduled.
- Works closely with both Wilmer billing and Office of Managed Care to keep abreast of ever- changing payor procedures
- Works closely with Wilmer IT for continued evaluation of EPIC documentation and workflows needed to improve communication errors adding to ultimate denials.
- Reviews with patients all pre / post procedure instructions and assists with necessary forms for completion. Obtains needed signatures and scans documents into Epic.
- Reviews with patients all insurance requirements before procedure and works with the patient and billing office to ensure all proper financial arrangements have been made.
- For international patients, works with the International Office to ensure financial clearance and scheduling.
- Ensures that all patient questions have been answered by the appropriate staff.
- Coordinates details for each procedure, inclusive of time sensitive appointments for series injections.
- Works with financial clearance and production unit staff to assist patients in financial need.
- Works with social worker to assist patients with resource challenges.
- Works with the staff to develop, implement and manage systems to ensure all required components are completed for intravitreal treatment patients, i.e., consents and waivers.
- Speaks to each patient in a kind and professional manner.
- Works collaboratively with others.
Minimum Qualifications
- High School Diploma / GED.
- Three years experience in similar service–oriented industry.
- Basic computer skills.
Preferred Qualifications
- Two years’ experience in related field and/or JHHS entity.
- Knowledge of medical insurance and/or medical terminology.
Classified Title: Clinical Program Coordinator
Job Posting Title (Working Title): Retina Drug Coordinator
Role/Level/Range: ATO 40/E/03/OE
Starting Salary Range: $18.00 - $33.50 HRLY ($61,620 targeted; Commensurate with experience)
Employee group: Full Time
Schedule: Monday-Friday, 8:30 am - 5:00 pm
Exempt Status: Non-Exempt
Location: School of Medicine Campus
Department name: SOM Oph Retina Service
Personnel area: School of Medicine