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Lead Intake/Authorization Specialist

BioScrip, Inc.
is the largest independent national provider of infusion and home care management solutions, with approximately 2,100 teammates and nearly 70 service locations across the U. S.
BioScrip partners with physicians, hospital systems, payors, pharmaceutical manufacturers and skilled nursing facilities to provide patients access to post-acute care services. BioScrip operates with a commitment to bring customer-focused pharmacy and related healthcare infusion therapy services into the home or alternate-site setting. By collaborating with the full spectrum of healthcare professionals and the patient, BioScrip provides cost-effective care that is driven by clinical excellence, customer service, and values that promote positive outcomes and an enhanced quality of life for those it serves. Ours is a fast-paced dynamic work environment with room for new ideas and opportunities for career advancement. We offer a wide array of welfare benefits as well as Tuition Reimbursement, an Employee Referral Program, and a 401(k) Retirement Savings.

We are seeking a
Lead Intake/Authorization Specialist
to join our team.
SUMMARY
This position is responsible for processing all new patient referrals, managing current patient base and providing support to the Intake/ Authorization Manager. Acts as a team lead by assisting management in training team members and overseeing workflow.
The main objective is to clear all patients prior to service in order to ensure timely and proper claim payments and in compliance within all legal and regulatory parameters, in cooperation with all other branch departments, and as an efficient and profitable business center.
ESSENTIAL FUNCTIONS
To perform this job successfully, an individual must be able to perform each essential function satisfactorily, with or without reasonable accommodation.
  • Assists in building a high quality, service-oriented intake/ authorization team by training new employees and addressing ongoing training needs within the department.
  • Works with staff to continually develop and implement ideas for delivering high quality, cost-effective services. Coordinates workflow within the department to ensure timely processing of referrals.
  • Communicates any ideas for departmental process improvements to Intake Manager.
  • Evaluates referrals against branch service model parameters.
  • Complies with reimbursement for products and services in compliance with Company policy and goals, to include drug, supply, and equipment selection and utilization, and participates in the submission of clean claims through compliance to proper pharmacy billing procedures.
  • Communicates with various payors, referral source, patients and sales representatives.
  • Verifies eligibility and benefits accurately and in a timely manner in accordance with Company policies.
  • Obtains initial authorizations following Company policy and maintains authorizations extension for all patients as appropriate. May obtain written prescription orders from physicians.
  • Processes all required paperwork according to established procedures. Ensures all documentation needed for billing is collected prior to or soon after accepting the referral.
  • Answers telephone calls and emails in a professional and timely manner.
  • Performs other duties as assigned.
EDUCATION, TRAINING AND EXPERIENCE REQUIREMENTS
  • High school diploma or equivalent is required;
  • National pharmacy technician certification preferred;
  • Successful completion of an approved/accredited pharmacy technician training program preferred;
  • Minimum of three to five (3-5) years of experience with medical insurance authorization in infusion services or other healthcare profession;
  • Minimum of one (1) year customer service required;
  • Home infusion, durable medical or respiratory equipment experience on the provider or payor side is required;
  • Experiential requirements may be waived in lieu of evidence of progressive growth in and attainment of the skills necessary to perform the required duties.
KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
The requirements listed below are representative of the knowledge, skill, and/or ability required, with or without reasonable accommodation.
  • Knowledge of HCPC Codes and ICD-9 Codes and maintains up to date professional knowledge of Medicare, Medicaid and the insurance industry requirements for qualifying services.
  • Ability to foster a cooperative work environment.
  • Strong interpersonal and communication skills and the ability to work effectively with branch departments.
  • Knowledge of computerized information systems, including financial applications.
  • Knowledge of infusion pharmacy, durable medical and respiratory equipment reimbursement for state, federal and commercial payors.
  • Basic pharmacy knowledge of reading and interpreting prescriptions
  • Ability to develop and maintain recordkeeping systems and procedures.
  • Knowledge of the computer and its capabilities.
  • Working knowledge of medical terminology.
  • Ability to perform work in an organized fashion with focus on complete information and time related deadlines.
  • Ability to complete multiple projects with time sensitive deadlines.
  • Ability to manage more than one priority project at a time.
  • Ability to work as part of a team to complete assigned tasks.
  • Ability to exercise independent judgment and at times work independently.
  • Ability to accept direction and complete work according to instruction.
  • Ability to enlist cooperation of other people and department in completing assigned work and projects.
  • Ability to work under high levels of stress.
  • Ability to prioritize and handle multiple tasks and projects concurrently.
  • Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.
  • Excellent verbal and written communication skills.
  • Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office, ACT, CPR+.
  • Ability to work with confidential material and maintain confidentiality along with sensitivity to employee s needs and data.
  • Strong attention to detail.
  • Strong analytical skills.
Language Skills
Ability to read, analyze and interpret information appropriate to duties and responsibilities assigned. Ability to operate information systems, follow policy, complete required forms, and prepare reports. Ability to effectively present information and respond to questions from referral sources, managers, patients, employees, payors and the general public.
Mathematical Skills
Ability to calculate and perform basic mathematical calculations such as pharmaceutical calculations, discounts, percentages, and volume.
Reasoning Ability
Ability to define problems, collect data, establish facts, and draw valid conclusions.
BioScrip is an equal opportunity employer. All employment decisions are made without regard to age, color, race, ancestry, national origin, disability, genetic information, military status, religion, creed, sex, pregnancy, childbirth, marital status, citizenship, sexual orientation, gender identity, gender expression, legally protected medical condition, or any other basis prohibited by applicable law. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.


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