HTC Business Coordinator - Orthopaedic Institute for Children
Los Angeles, CA 90007
About the Job
Position Summary: The Hemophilia Business Coordinator is responsible for reviewing the hemophilia and FACTOR package for each patient and ensures all necessary information is collected for authorization, billing, in accordance to payer’s professional fees and supports patients with assistance programs. Candidate will collaborate with the Business Office Department, Pharmacy and The Hemophilia Treatment Center and their contracted entities on an ongoing basis. This position will actively be involved in FACTOR product manufacturer contracts, private, HMO and government insurance contract communication and will participate in Hemophilia Alliance business cycle education and contracting updates to keep abreast of changes. Communicates effectively with all parties to assist in resolving any business cycle and reimbursement issues in a timely manner.
Duties and Responsibilities:
- Reviews FACTOR billing Package to assure all documentation is uploaded to the shared folder on a daily basis.
- Screens and assists patient eligibility, authorization status and primary payer information via CareConnect and Insurance portals
- Screens data reports and charge posting functions for FACTOR products services as needed.
- Reviews FACTOR claims monthly to reconcile with tracking sheets
- Reviews third party vendors’ follow-up functions for FACTOR products and HTC medical providers as needed.
- Collaborates with business office in working EOBS and Denials. Works with all parties and communicates to see who needs what information or action taken to reach resolution.
- Review and enter as needed the shared 340B spreadsheet on the Finance Department/Pharmacy shared drive
- Assist with HTC, Pharmacy and Lab phone calls in regard to billing inquiries, benefit coverage and patient inquiries as needed.
- Collaborate with business office, pharmacy, lab, HTC for problems and resolutions of business cycle issues
- Advocate for patient needs and work to overcome financial barriers to treatment access.
- Communicates with the business office on a case by case basis as needed.
- Participates in on going quarterly training meetings. Travel may be needed for some training meetings
- Attend meetings with the HTC and Pharmacy directors monthly.
- Other duties as assigned.
Patient Enrollment in Copay Assistance Programs:
- Assist patients in enrolling in available copay assistance programs.
- Educate patients about the benefits and requirements of copay assistance.
- Maintain up-to-date records of patients enrolled in copay assistance programs.
- Maintain records of Charity Care for those that do not qualify
- Maintain records of those who have filed a co-pay waiver and can into the shared folder. Each patient should have a waiver they sign at least once per year.
Data Input into the American Thrombosis and Hemostasis Network (ATHN):
- Accurately input patient data into the ATHN system.
- Ensure data integrity and compliance with regulatory standards.
- Generate and analyze reports from the ATHN database as required.
Authorization for Gene Therapy:
- Collaborate with gene therapy manufacturer for payment contracts and payment schedules.
- Collaborate with HTC team for the specific needs for the individual and product for each patient.
- Obtain necessary authorizations for gene therapy treatments from insurance companies.
- Gather and submit all required documentation to support authorization requests.
- Follow up with insurance companies to ensure timely approval of gene therapy treatments.
Hemophilia Alliance Usage Reports:
- Prepare Hemophilia Alliance usage reports to monitor and maximize prompt payments and rebates.
- Analyze data to identify opportunities for increasing financial efficiency.
- Work with internal and external stakeholders to ensure optimal usage of resources and maximize financial returns.
Patient survey feedback:
- Collect patient feedback through yearly surveys and focus groups to identify barriers to adherence or access and areas for improvement.
- Collaborate with the HTC, pharmacy, lab, business office to improve patient care based on patient feedback and ongoing monitoring of results.
Performance Standards and Success Indicators:
- FACTOR packages are complete with authorizations and proof of medical necessity upon receipt charges obtained from the pharmacist.
- Problems presented to Pharmacy and HTC directors within 24 hours of realization of problem.
Qualifications:
- Usual education and experience needed for satisfactory performance is a high school graduation or GED equivalent.
- Knowledge of computer programs (Microsoft office) and billing programs along with other office equipment. (copier, scanner, FAX).
- Good communication skills both orally and in writing.
- Ability to communicate with the staff, the public, and business entities in person, over the telephone and virtually, in a tactful and professional manner.
- 2 years of billing knowledge preferred.
Complexity:
- Ability to perform highly detailed work with sustained attention while providing/obtaining information on numerous inquiries is paramount to success in this position.
- High level of communication skills in patient and business settings is required.
- Multi-tasking is a necessity.
- Self-starter. Proactively looks for, finds, and resolves problems.
- Through collaboration with all those needed communicates to find resolution to business cycle problems.
Physical Requirements:
- Intermittent (25-35% of the time) walking, standing, bending, sitting and verbally communicating with patients and other OIC healthcare team members.
- Requires normal range of vision.
- Requires infrequent lifting up to 25 pounds.
- Requires prolonged standing or sitting.
WORK ENVIRONMENT:
- Work is performed indoors in a heated, air conditioned, well lighted and clean office setting.
Source : Orthopaedic Institute for Children
