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J212167

Senior Billing Associate - AHN Home Infusion

Allegheny Health Network

  • Company AHN
  • Home, PA
  • Finance
  • Full time
  • Day (United States of America)

Company :

Allegheny Health Network

Job Description : 

GENERAL OVERVIEW:

This position is critical in providing caring, courteous, and efficient processing of the customer’s needs, including referrals, orders, verifications, authorizations, follow-up, supply requests, and routing of incoming calls to the appropriate person or department. This position includes tracking and invoicing of contracted nursing visits and entry of patient data in CPR+.

ESSENTIAL RESPONSIBILITIES:

  • Receive patient information from clinical intake staff, verify insurance benefits with payer(s), and communicate back to clinical intake staff. Document all communication in CPR+ under the verification tab, also add as a progress note and infusion tab on JIRA.
  • Adjudicate all pharmacy test claims to determine copay as part of the verification.
  • If patient meets criteria, call directly to discuss payment of copay or self-pay, as well as obtain payment prior to start of care.
  • Create consents/financials to be sent with initial delivery. Track receipt of consents or obtain verbal approval for billing.
  • Process request for authorizations/re-authorizations when required. Add and track in CPR+.
  • Determine in CPR+ if nursing is bundled/unbundled and if Cath-Flo is covered.
  • Create/track Medicare ABN forms in CPR+ as required.
  • Review clinical documentation to confirm Medicare guidelines. Work with other providers if AHNHI is unable to bill for services by transitioning the referral directly.
  • Communicate with nursing and pharmacy regarding administration requirements babsed on payer. 
  • Prepare daily pending reports for both sites. 
  • Thorough knowledge of and strict adherence to Allegheny Health Network Home Infusion’s Mission, Vision, and Core Values.
  • Perform other duties as assigned by management.

QUALIFICATIONS:

Minimum

  • High school diploma or equivalent

Preferred

  • Experience in home infusion, pharmacy, and/or medical reimbursement

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


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