Performing patient level benefits verifications as applicable for all major medical and pharmacy benefits plansAccurate documentation of benefits in the CAPS systemCompletion of the template forms that provide patient level benefits Coverage Determination Summary, as applicable.As applicable, coordination of prior authorizations based on payer guidelines and in compliance with law, regulation or guidancePatient Assistance QualificationsReview of patient assistance enrollment forms and any supporting documentation to assess patient eligibility for participation as per SOPs and program guidelinesDetermination of patients eligibility based upon program criteria for qualificationCommunication of patients eligibility to patient based upon program criteria for qualificationCommunication of patients eligibility to the respective consignment pharmacyReporting of Adverse Events/ Product Complaint inquiries received in accordance with SOP and good manufacturer practicesOther duties as assigned by manager

Greet customers, completes full patient registration at date of service adheres to financial & cash control policies & procedures, thoroughly explain and secure Hospital & patient legal forms (i.e., Advance Directives, Conditions of services, Consent for treatment, Important Message from Medicare, EMTALA, etc.).• Scan Protected Health Information, create and file patient information packets/folders for upcoming Hospital services. • Assist with scheduling diagnostic or surgical procedures, conducting physician office/patient interviews, and explains hospital procedure guidelines and policies.• Provides full patient financial counseling, education & referrals, employs and completes all patient liability collection escalations through proper, compliant patient liability collection techniques before, during & after date of service, performs Hospital cash reconciliation & secured payment entry in adherence to financial & cash control policies & procedures.• Secures medical necessity checks/verification in accordance to Centers for Medicare & Medicare services, verifies insurance, benefits, coverage & eligibility, completes assigned registration financial clearance work lists activities, obtains insurance authorizations for scheduled & unscheduled Hospital services, and secures inpatient visit notification to payors.• Performs thorough analysis of admission discharge transfers (ADT), Revenue Cycle Reports, leads shift Patient Access Operations, and collaborates with Department leaders in process and operational excellence.

•Admits new clients by reviewing records and applications; conducting orientations.•Determines clients' requirements by completing intake interviews; determining need for therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist evaluations, treatment objectives, and plans. Also establishes treatment programs by setting schedules and routines; coordinating services being provided; arranging resources, including transportation and escort.•Maintains clients' records by reviewing case notes; logging events and progress.•Communicates clients' progress by conducting weekly interdisciplinary meetings and evaluations; disseminating results and obstacles to therapeutic team and family; identifying treatment influences.•Prepares clients' discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members; providing resources.•Improves staff competence by providing educational resources; balancing work requirements with learning opportunities; evaluating the application of learning to changes in treatment results.•Improves treatment results by studying, evaluating, and re-designing processes; implementing changes; rewriting policies and procedures.•Improves financial status by analyzing results; monitoring variances; identifying trends; recommending actions to management.•Prepares reports by collecting, analyzing, and summarizing treatment and results data and trends; compiling statistics; completing grant and subsidy applications.•Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.•Enhances department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

▪ Acquired reputation for dependability and helpfulness with staff and patients/customers▪ Perform drug program research to create cost efficient options for patients with high co-payments▪ Answer any questions from patients or nurses pertaining to insurance or benefits▪ Perform rebilling and medical coding for patients; utilize ICD-9 codes when applicable▪ Initiate and complete prior authorizations, insurance verifications and Specialty Release 2 systems (SR2)▪ Prepare specialty medication for oncology, transplant, and HIV patients▪ Follow proper guidelines and recipes for sterile compounding and record findings in standardized forms

▪ Supervised and train new pharmacy technicians▪ Mixed and assay medications to determine identity, purity and strength of pharmaceutical preparations▪ Resolved Third Party insurance rejections to correct expired or invalid data in the patient’s profile▪ Entered patient, prescribed medication and cost data to maintain files, charge system and inventory▪ Performed pharmaceutical audits and inventory control to ensure accurate patient information using Intercom Plus