Job Description

· Ability to form positive and collaborative relationships with all levels in the organization.

· This position requires strong organizational and excellent communication skills as well as being highly motivated and detail oriented.

· Possess the ability to identify gaps or problems in business processes and develop ideas to resolve them.

• Must have a strong sense of team commitment, which includes meeting deadlines, punctuality and excellent follow-through and feedback.
• Must display a high level of integrity and initiative.
• Ability to perform research and understand complex regulatory documents and legal language.
• Strong relationship building skills with the ability to delegate and mentor.

Responsibilities

• Works with each department (Physicians, clinical staff, managed care, operations, and insurance) to create and maintain open communication to optimize work performance and productivity.
• Individual should have a strong background in drug formulary and can perform medical dosage calculations.
• Monitor the purchasing of chemotherapy, infusion drugs.
• Ensure patient accounts are current and authorization process is being followed per policy and procedure guidelines.
• Maintain monthly records and reports for all infusion drugs. Meet with leadership and various departments as needed.
• Work with drug companies and their representatives in relation to drug reimbursement.
• Responsible for checking all drug prices and updating any drug contracts associated with discounts and or rebates.
• Responsible for screening the physician’s order for each drug regiment to ensure all diagnosis codes reported accurately reflect the patient’s condition.
• Responsible for checking patient’s accounts periodically to assure that drugs are being properly coded and reimbursed accordingly.
• Monitor various aspects of contract reimbursement and investigates differences between expected and actual reimbursement.
• Ensure that after careful evaluation of each drug regimen a reasonable profitability will be made.
• Keep abreast of new chemotherapy and other infusion drugs and J-codes. Responsible for informing coders and insurance department of any changes.
• Investigate new Patient Assistance Programs and work with such programs to aid patients with financial and therapeutic needs.
• Stay abreast of active Patient Assistance Programs and/or grant deadlines and follow through on behalf of the patient to ensure funding is fully recognized.
• Collect and post monies on Infusion and Chemotherapy services.
• Partner with patients to ensure a full understanding of Infusion and Chemotherapy services and financial expectations.
• Working knowledge of ICD-10 and CPT4 procedural coding systems.
• Keep abreast of regulatory and contract changes affecting Medicare, Medicaid, and managed care reimbursement.
• Prepares reports and analysis as required using necessary software.
• Identify and communicate to management any concerns, which could result in an adverse impact to the company’s cash flow.
• Acts as a liaison to the software vendor and IS to identify and correct system problems and to advise of system upgrades.
• Participates in special assignments as requested.
• Follow and uphold all HIPAA rules and regulations.
• This job description in no way states or implies that these are the only duties to be performed by this employee. He or she will be required to follow any other instructions and to perform any other duties requested by his or her supervisor.
• Attend and participate in facility meetings as requested.

Candidate requirements:

An Associate Degree in a medical field of study is preferred. In some cases, other appropriate education and professional training in a health care profession may be substituted provided the individual possesses the required knowledge, skills, and abilities. A strong insurance background required. Competent in the use of Nextgen and AthenaFlow software required. The ability to interact effectively with physicians, mid-level providers, clinical and non-clinical employees as well as the public and vendors is paramount.

Affirmative Action/EEO statement

Physicians East, P.A. is an equal opportunity employer and will not discriminate against any applicant or employee on the basis of age, race, color, ethnicity, religion, creed, sex (including gender, pregnancy, sexual orientation, and gender identity, which includes status as a transgender individual), national origin or ancestry, citizenship, past, current, or prospective service in the uniformed services, genetic information (including family medical history), physical or mental disability, or other legally protected status. Reasonable accommodation will be made for persons with disabilities during the application process and/or at the time of employment. Requests for accommodation should be made to the Human Resources Department as early as possible in the application/employment process. Contact HR Office at 252-413-6368 or email careers@physicianseast.com

Disclaimer

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

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