Hybrid Retina Drug Coordinator (Baltimore, MD, United States, 21287) at Johns Hopkins University

We are seeking a Retina Drug Coordinator who will manage all administrative aspects of the patient encounter involving intravitreal injection therapy. This includes accurate data entry on each patient to facilitate the appropriate pre-certification of therapy, expediting the check-in / check-out process, and afford appropriate billing.

Specific Duties & Responsibilities

• Confirms all needed forms are up to date, and signed (Outpatient agreement, consents)
• Obtains pre-certification as required by patient’s healthcare insurer or managed care provider.
• Obtains preauthorization for retina drug injections with following the insurance guidelines process.
• Checks over provider schedules 2 weeks in advance for errors and repeats within 48 hours of date of service for any urgent additions.
• Follows payer guidelines.
• Follows ICD-10 codes to ensure diagnosis codes are appropriate for each retina drug prior to claim submission.
• Follows limiting coverage guidelines for diagnosis coding by using LCD/NCD/payer policy information and assigns appropriate modifiers based on departmental policy.
• Maintains familiarity with various types of insurances. Contacts insurance carriers for clarification of coverages to avoid denials of payment.
• Monitors and responds to assigned work queues.
• Provides support to both East Baltimore and satellite clinics during events of short staffing ( sickness, vacation, meetings)
• Guides patients and families to appropriate resources (financial counselors, international office, social worker, drug copay assistance programs)
• Assists in enrolling patients in drug copay assistance programs and tracking payments.
• Verifies insurance information for each injection scheduled.
• Works closely with both Wilmer billing and Office of Managed Care to keep abreast of ever- changing payor procedures
• Works closely with Wilmer IT for continued evaluation of EPIC documentation and workflows needed to improve communication errors adding to ultimate denials.
• Reviews with patients all pre / post procedure instructions and assists with necessary forms for completion. Obtains needed signatures and scans documents into Epic.
• Reviews with patients all insurance requirements before procedure and works with the patient and billing office to ensure all proper financial arrangements have been made.
• For international patients, works with the International Office to ensure financial clearance and scheduling.
• Ensures that all patient questions have been answered by the appropriate staff.
• Coordinates details for each procedure, inclusive of time sensitive appointments for series injections.
• Works with financial clearance and production unit staff to assist patients in financial need.
• Works with social worker to assist patients with resource challenges.
• Works with the staff to develop, implement and manage systems to ensure all required components are completed for intravitreal treatment patients, i.e., consents and waivers.
• Speaks to each patient in a kind and professional manner.
• Works collaboratively with others.

• High School diploma or graduation equivalent.

• Three years related experience.

• Additional education may substitute for required experience, and additional related experience may substitute for required education beyond HS Diploma/Graduation Equivalent, to the extent permitted by the JHU equivalency formula.

• Two years’ experience in related field and/or JHHS entity preferred.
• Knowledge of medical insurance and/or medical terminology preferred.

Classified Title: Clinical Program Coordinator 
Job Posting Title (Working Title): Retina Drug Coordinator   
Role/Level/Range: ATO 40/E/03/OE  
Starting Salary Range: $18.20 - $33.90 HRLY ($29.00/hour targeted; Commensurate w/exp) 
Employee group: Full Time 
Schedule: Mon-Fri, 8:30am-5:00pm 
FLSA Status: Non-Exempt 
Location: School of Medicine Campus  
Department name: SOM Oph Retina Service  
Personnel area: School of Medicine