Infusion Operations Specialist

Infusion Operations Associate

• The Infusion Operations Associate will support the implementation and growth of Infusion services across a site or sites; serve as a generalist and/or flex resource based on need
• Participate in various activities to promote the development, quality, and coordination of Infusion services across many stakeholders and functions; develop a plan to improve, streamline, and increase the efficiency and effectiveness of the Infusion program
• Support oversight of Medical Intake Coordinators and other resources aligned to Infusion program; develop processes for tracking referrals, prior authorizations and appeals, and patient engagement
• Participate in discussions to help identify and solve for root causes of presented opportunities and/or causes of denied claims; develop workflow solutions to optimize patient care and engagement
• Participate in the development, implementation and evaluation of policies and procedures; assist Operations teams with the development of new policies and procedures and assure timely review and revision of procedures as the program expands.

Key Responsibilities

• Support onboarding and training of new hires supporting Infusion services, including Medical Intake Coordinator, Medical Billing Specialist, and Nursing Coordinator; host Medical Billing Training (Week 4)
• Serve as Stabilizer and/or support stabilization (Weeks 5 and 6) of new hires into clinics and/or workflows
• Conduct frequent audits on people, processes, and workflows to uphold quality and compliance standards as well as ensure consistency across the team
• Work with Operations and Implementation teams to develop workflows and recommend enhancements to improve as necessary; support day-to-day operations, new clinic implementations and other growth initiatives
• Develop and refresh written training materials and/or job aids when needed specific to site, initiative, and/or role; perform both gap and quality analyses regularly to ensure materials are current and relevant based on changing factors
• Support ongoing development of team through one-on-one sessions, refresher workshops, and creation of educational material/job aids/presentations; monitor team productivity
• Support creating weekly outline and gameplan to ensure all activities, tasks, and to-dos are completed on time; monitor communications in real time to catch or prevent any issues
• Launch new clinics as the in-seat resource until permanent resource is identified, hired and trained
• Provide transitional coverage support for FMLA, voluntary / involuntary transitions, and other coverage gaps (including short- and long-term PTO)
• Provide education and serve as subject matter expert about the Shields/Health System Infusion Care Model to clinic leadership, staff, patients and other stakeholders
• Compile, monitor, analyze, audit and present data to internal teams and make recommendations as needed; monitor outlined key metrics and KPIs on regular basis to improve operational and financial performance
• Engage and partner with Regional leaders and participate in team meetings, discussions, and initiatives to establish “one team” identity
• Facilitate communication between multiple teams and proactively share information pertaining to new initiatives, best practices, changes in the way we do things proactively
• Assist in identifying gaps in the onboarding and training process, as well as other opportunities to support development and growth of our team
• Problem solve and collaborate with other members of the team when schedules, priorities, and needs of the business are not in sync
• Support development of meeting agendas with team, clinics, and other key stakeholders (internal and external); support outline/recap of next steps
• Participate in interview process
• Perform other tasks and responsibilities at the discretion of their direct manager and/or leadership of the site they are actively supporting

Experience/Requirements

• High school education or equivalent required
• Current certification and/or licensure as a Pharmacy Technician required? A national OR state? And what state (is it where they live or any state?)
• 3-5+ years health care experience required; 3+ as a pharmacy technician required 
• 1+ years in a supervisory or leadership role required; 3+ years preferred
• 3+ years’ experience with infusions, coordinating and subcontracting referrals, infusion and medical reimbursement required; experience must include medical pre-certification, benefits investigation, prior authorization, and financial assistance; 2+ years of experience specific to home infusion preferred
• Strong interpersonal skills, strong verbal and written communication skills
• Strong mathematical skills, including calculating doses, out of pocket costs based on benefits
• Strong time management skills
• Understands the pre-certification process for specialty/non-specialty infusions; knowledge and understanding of nuances of infusion therapy v. “standard” outpatient specialty pharmacy
• Knowledge of infused specialty medications preferred; knowledge of common home infusion J-codes and HCPC codes (including per diem and nursing) preferred
• Experience with major and local medical plans preferred; strong knowledge of Medicare and Medicaid regulations and commercial insurer criteria for payment of infusion and home care services
• Highly proficient in navigating various systems including: EMR’s (e.g., EPIC, Cerner), and dispensing systems (e.g. CPR+, EPIC WAM) etc.

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