Get new jobs for this search by email

Consultant, Patient Services Representative, Medical Devices

Summary

Our client, an innovative global leader within medical devices , has engaged GForce Life Sciences to provide a Patient Services Representative (PSR). The Patient Services Representative’s responsibility is to verify eligibility, confirm benefits and process pre-authorization, if required. PSRs coordinate with the sales force to collect patient data and inform them when a device is good to apply. If a pre-authorization denial is received, the PSR will be required to review the denial and determine if an appeal/reconsideration is necessary (meets medical criteria, etc.), to proceed with obtaining authorization prior to billing.

Job Duties

• Examine all documentation received with new orders inclusive of patient demographics, clinical documentation, and other insurance related documents (i.e., authorizations, sales proposals, etc.) for accuracy and determination of insurance carrier medical criteria. Tasks carried out are specifically as follows:
• Demonstrate product knowledge in relation to the information being submitted.
• Review medical documentation and exhibit knowledge through accurate summarization in file, as it relates to medical necessity / insurance criteria.
• Demonstrate the ability to document all related job requirements in the FileNet database specifically as follows:
• Exhibit knowledge of workflow, including general knowledge of department workflow.
• All message documentation must be appropriate and reflect accuracy.
• Accurately identify the Sales Rep and prescribing physician for all orders being processed through accurate documentation and completion of corresponding FileNet fields.
• Accurately complete medical tab as supported by medical documentation
• Accurately complete all tab requirements in relation to Sales commissions and payer requirements.
• FileNet Code knowledge as it relates to processing, workflow, and payer requirements (Insurance Type, Revenue Code, Policy Type, etc.).
• Accurately document Insurance benefits and authorization information.
• Summarize denial and appeals information.
• Contact the insurance carriers for verification of insurance eligibility and benefits and to initiate the pre-authorization process, if necessary. The following procedures are carried out, when determined to be applicable:
• Pursue retro-authorizations, when required.
• Identify, analyze and process appeals for denied pre-authorizations.
• Contact a Healthcare Policy & Payer Relations Director (RD) regarding contracting, criteria and pricing issues i.e., incorrect contract pricing, advise regarding non-contracted insurance carriers, constructing Letters of Agreement for non-contracted insurance carriers, etc.
• Act as the primary resource and liaison with the Sales Force and physician’s office to collect, communicate, and deliver medical information and necessary forms, ensuring all required information submitted is accurate.
• Handle and advise on all requested escalated orders as it relate to their affiliated BPO team.
• Manage & maintain all documentation required for audit site visit.

Requirements

· Associates degree

· Minimum of 0-4 years of customer service experience and/or medical background

Preferred Qualifications

· Knowledge or understanding of commercial insurance, Medicare, Medicaid, and other governmental and private insurance products, specifically the verification and authorization processes

· Medical terminology and health insurance background

· Understanding of health insurance concepts and benefit design

Term & Start

· 2-4 days onsite in Birmingham, AL

· 9-month contract, possibility of converting to FT