Pre-Cert Coordinator - Infusion

Oklahoma Arthritis Center; Edmond (OK); On-site; USD 40,000 - 60,000; Full time

Job summary

Oklahoma Arthritis Center in Edmond, OK seeks a Patient Benefits Coordinator to join the benefits coordination team. You will verify benefits, calculate patient due amounts, communicate payment expectations, and ensure compliance with HIPAA and healthcare policies.

The role requires strong customer service, attention to detail, and experience with medical insurance, benefits verification, prior authorizations, and EHR systems.

Qualifications

• Associate's or Bachelor's degree in healthcare, business, finance, or related field, or equivalent experience.
• 2–3 years of experience with medical insurance, benefits verification, prior authorizations, medical billing, or related field.
• Excellent customer service skills and attention to detail.
• Knowledge of Medicare, Medicaid, third party vendors, and patient assistance programs.

Responsibilities

• Verify benefits and eligibility for new and existing patients, including prior authorizations.
• Calculate patient due portions based on insurance and verification data.
• Communicate with patients about payment expectations and copay responsibilities.
• Understand insurance concepts, drug cards, major medical, and government/patient assistance programs.
• Validate patient copay assistance programs.
• Process external infusion referrals and review payment records for accuracy.
• Answer calls and manage voicemails promptly.
• Maintain HIPAA compliance and adhere to policies.

Skills

Customer service

Attention to detail

Analytical skills

Communication

Microsoft Office

EHR experience

Education

Associate's or Bachelor's degree in healthcare/business/finance

Tools

EHR system

Outlook

Word

Excel

PowerPoint

Job description

Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.

Job Summary

Working as a part of the Patient Benefits Coordination team, this employee will be responsible for daily financial coordination functions, patient relations, compliance, learning and development, and process development and significant contribution to the team.

Essential Functions

• Verifying benefits and eligibility for both new and existing patients to process patient benefits in a timely manner; including necessary prior authorizations
• Calculates patient due portions based on insurance and pharmacy verification
• Communicates with patient on their payment expectations
• Understanding insurance carriers and concepts including drug cards, major medical and pharmacy benefits, and knowledge of government and patient assistance programs
• Validating patient copay assistance programs
• Processing all outside infusion referrals
• Reviewing payment records for patients and third parties, ensuring fees are collected properly
• Answering phone calls and returning voicemails in a timely manner
• Checking and resolving assigned tasks in Electronic Health Record
• Adhere to compliance of OAC policies and standard operating procedures
• Set the standard for the team with excellent patient care
• Be available to team to offer assistance, information, and directions
• Maintain open and positive lines of communication, and functionality
• Understand and adhere to HIPAA laws and regulations in compliance and patient confidentiality

Performance Requirements

Knowledge

• Pharmacy, PBM, or Specialty pharmacy experience a plus
• Knowledge of government and patient assistance programs
• Excellent customer service skills
• Attention to detail
• Analytical and problem solving skills
• Knowledge of Medicare, Medicaid, and third party vendors
• Proficient in Microsoft - Able to type 50 words per minute
• EHR system experience
• Office (Outlook, Word, Excel, PowerPoint)

Qualifications

• Associate’s or Bachelor’s degree in healthcare, business, finance, other related field, or equivalent experience, a plus
• 2-3 years of experience with medical insurance, benefits verification, prior authorizations, medical billing, or a related field

Physical Requirements

• Ability to work effectively in a fast-paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel Requirements

Travel may be required.

Scheduled Working Hours

Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.

Other Duties

Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.

Equipment Operated

Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.