Retina Sacramento MSO LLC
Account Representative- Pharmaceutical Department (Sales)
As a result of high cost injectable drugs being used in the practice, the pharmaceutical (drug) department was created specifically to perform the pre-visit process for these drugs, and to follow-up on unpaid balances, to ensure that the practice would be paid for these injected drugs. For each scheduled drug injection patient, this department is responsible for obtaining and/or verifying insurance coverage and eligibility, investigating drug benefits, obtaining pre-authorization (if necessary), communicating to the patient their financial responsibilities (including past due balances) for services to be provided by the physician as well as helping the patient to access any financial or co-pay assistance programs available. The drug department is responsible for making reasonable efforts to collect the patient portion prior to the injection. The drug department also addresses any drug related insurance claim denials or outstanding accounts receivable balances. Additionally, the drug department is responsible for accounting for, and the proper storing of, the inventory of these high cost drugs at each clinic location.
Responsibilities
Interacting with patients face-to-face or via telephone regarding billing questionsComposing effective appeal letters for initial and second level appealsAssessing account balances and make determination on further actionsProvide co-pay assistance help to the patients- sending out packets, answering questions, enrolling online, and helping with information to qualify patients.Utilize payers websites to check claim and appeal statusAnswer the drug team queue calls from patients and clinics.Other duties as assigned