Texas Health Huguley FWS
Pre-Access Infusion Benefits and Authorization Specialist-ONCOLOGY
Texas Health Huguley FWS, Hinsdale, Illinois, United States, 60521
This service is set to disconnect automatically after {0} minutes of inactivity. Your session will end in {1} minutes.
Click OK to reset the timer to {0} minutes.You have been signed out.
This service is set to sign out after {0} minutes of inactivity.Job Description - Pre-Access Infusion Benefits and Authorization Specialist-ONCOLOGY (24017633)Job DescriptionPre-Access Infusion Benefits and Authorization Specialist-ONCOLOGY
(
Job Number:
24017633
)DescriptionAll the benefits and perks you need for you and your family:Benefits from Day OnePaid Days Off from Day OneStudent Loan Repayment ProgramDebt-free Education
(Certifications and Degrees without out-of-pocket tuition expense)Our promise to you:Joining AdventHealth is about being part of something bigger.
It’s
about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body,
mind
and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that
together
we are even better.Schedule:
Full
TimeShift
:
40 hours
a week, Typical business hoursLocation:
AdventHealth
HinsdaleThe role
you’ll
contribute:The Pre-Access Infusion Benefits and Authorization Specialist, under general supervision,
maintains
performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens and other injection/infusion treatments
.
Meet standards
established
by leadership for all patient services. Meets or exceeds department audit accuracy and productivity standard goal.
Uses
utmost caution that obtained benefits, authorizations, and/or pre-certifications are
accurate
according to the actual test, and procedure or registration being performed. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local,
state
and federal agencies and accrediting bodies. Actively
participates
in outstanding customer service and accepts responsibility
in
maintaining
relationships that are equally respectful to all.The value
you’ll
bring to the team:Responsible for review of chemotherapy regimen and other injection/infusion treatment orders and
determines
insurance benefits and authorization requirements. Reviews clinical data such as patient pathology reports, imaging, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines. Ensures specified medical terms, diagnosis, medication codes and supporting clinical documentations are met.
Utilization review to facilitate the sending of clinical information in support of the authorization to payor or third-party administrators, as assigned.Reviews medical records in detail to confirm the treatment is supported by approved medical studies by reputable oncology/hematology studies. Stays current on payer preference for biosimilar drugs available. Ensures patient orders are changed accordingly if biosimilar drug is preferred. Ensures that each treatment is coded, reviewed, and financially cleared based on the patient insurance requirements.Verifies medical necessity
in accordance with
Centers for Medicare & Medicaid Services (CMS) standards byreviewing guidelines and
communicates
relevant
coverage/eligibility information to the patient. Alerts physician offices to issues with verifying insurance. Responsible for communicating to service line partners of situations where medical necessity is not met to include review of journal articles,
compendia
and/or peer review to justify medical necessity
approvalReviews clinical records when following up on authorization request directly with a payor. Escalates peer to peer (insurance company physician requests to speak to ordering physician) requests to physician offices and
assists
in scheduling peer to peer requests with the office and the payer to ensure an authorization decision is made prior to date of service.Obtains initial and
subsequent
pre-authorization for chemotherapy treatments, as well as research protocols, on all new and existing patients and notes approvals in the electronic medical record.
Uploads treatment supporting documentation packet to the electronic medical record for Revenue Cycle billing and coding teams.Contacts insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance
eligibility and benefits and
determine
extent of coverage within established
timeframe
before scheduled appointments and during or after care for unscheduled patientsObtains pre-authorizations from third-party payers
in accordance with
payer requirements and within
established
timeframe
before scheduled appointments and during or after care for unscheduled patients. Accurately enters required authorization information in AdventHealth systems to include length of authorization, total number of visits, and/or units of medication. Convert orders and dosage to ensure the proper authorization is requested and approved, based on the units the payer has given.Maintains
a close working relationship with clinical partners and physician offices to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services departments by monitoring team e-mail boxes and phone calls to follow up on issues
timely
. Responsible for communicating to service line partners
of
situations where rescheduling is necessary, due to lack of authorization or limited benefits.Obtains PCP referrals when applicableAlerts physician offices
I
ancillary departments to issues with obtaining pre-authorizations. Conducts diligent follow-up on missing or incomplete pre-authorizations with third-party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as neededQualifications
Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashionAbility to communicate professionally and effectively, both verbally and writtenAbility to adapt in ever changing healthcare environmentAbility to follow complex instructions and procedures, with a close attention to detail•Adheres to government guidelines such as CMS, EMTALA, and HIPAA and AdventHealth corporate
policiesAdvanced understanding of insurance knowledge and benefits•Advanced understanding of hospital electronic medical record (EMR)
system•Basic medical
terminologyEDUCATION AND EXPERIENCE REQUIRED
:High School Grad or Equivalent. 2+
years' experienceOne (1) year experience in Oncology related business operations withinspecialty pharmacy or insurance verification, payor reimbursement guidelines, and/or authorization submission. Familiarity with medical terminology and concepts. Working knowledge with third party insurance
administrators
authorization and clinical care processes.One year of direct Patient Access experienceOne year of customer service experienceHigh School diploma or GEDEDUCATION AND EXPERIENCE PREFERRED:Two years of direct Patient Access
experienceMedical AssistantLICENSURE, CERTIFICATION OR REGISTRATION
PREFERRED
:Certified Healthcare Access Associate (CHAA)Certified Revenue Cycle Representative (CRCR)Job
Organization
Organization
:
UChicago Medicine AdventHealth Great Lakes
#J-18808-Ljbffr
Click OK to reset the timer to {0} minutes.You have been signed out.
This service is set to sign out after {0} minutes of inactivity.Job Description - Pre-Access Infusion Benefits and Authorization Specialist-ONCOLOGY (24017633)Job DescriptionPre-Access Infusion Benefits and Authorization Specialist-ONCOLOGY
(
Job Number:
24017633
)DescriptionAll the benefits and perks you need for you and your family:Benefits from Day OnePaid Days Off from Day OneStudent Loan Repayment ProgramDebt-free Education
(Certifications and Degrees without out-of-pocket tuition expense)Our promise to you:Joining AdventHealth is about being part of something bigger.
It’s
about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body,
mind
and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that
together
we are even better.Schedule:
Full
TimeShift
:
40 hours
a week, Typical business hoursLocation:
AdventHealth
HinsdaleThe role
you’ll
contribute:The Pre-Access Infusion Benefits and Authorization Specialist, under general supervision,
maintains
performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens and other injection/infusion treatments
.
Meet standards
established
by leadership for all patient services. Meets or exceeds department audit accuracy and productivity standard goal.
Uses
utmost caution that obtained benefits, authorizations, and/or pre-certifications are
accurate
according to the actual test, and procedure or registration being performed. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local,
state
and federal agencies and accrediting bodies. Actively
participates
in outstanding customer service and accepts responsibility
in
maintaining
relationships that are equally respectful to all.The value
you’ll
bring to the team:Responsible for review of chemotherapy regimen and other injection/infusion treatment orders and
determines
insurance benefits and authorization requirements. Reviews clinical data such as patient pathology reports, imaging, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines. Ensures specified medical terms, diagnosis, medication codes and supporting clinical documentations are met.
Utilization review to facilitate the sending of clinical information in support of the authorization to payor or third-party administrators, as assigned.Reviews medical records in detail to confirm the treatment is supported by approved medical studies by reputable oncology/hematology studies. Stays current on payer preference for biosimilar drugs available. Ensures patient orders are changed accordingly if biosimilar drug is preferred. Ensures that each treatment is coded, reviewed, and financially cleared based on the patient insurance requirements.Verifies medical necessity
in accordance with
Centers for Medicare & Medicaid Services (CMS) standards byreviewing guidelines and
communicates
relevant
coverage/eligibility information to the patient. Alerts physician offices to issues with verifying insurance. Responsible for communicating to service line partners of situations where medical necessity is not met to include review of journal articles,
compendia
and/or peer review to justify medical necessity
approvalReviews clinical records when following up on authorization request directly with a payor. Escalates peer to peer (insurance company physician requests to speak to ordering physician) requests to physician offices and
assists
in scheduling peer to peer requests with the office and the payer to ensure an authorization decision is made prior to date of service.Obtains initial and
subsequent
pre-authorization for chemotherapy treatments, as well as research protocols, on all new and existing patients and notes approvals in the electronic medical record.
Uploads treatment supporting documentation packet to the electronic medical record for Revenue Cycle billing and coding teams.Contacts insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance
eligibility and benefits and
determine
extent of coverage within established
timeframe
before scheduled appointments and during or after care for unscheduled patientsObtains pre-authorizations from third-party payers
in accordance with
payer requirements and within
established
timeframe
before scheduled appointments and during or after care for unscheduled patients. Accurately enters required authorization information in AdventHealth systems to include length of authorization, total number of visits, and/or units of medication. Convert orders and dosage to ensure the proper authorization is requested and approved, based on the units the payer has given.Maintains
a close working relationship with clinical partners and physician offices to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services departments by monitoring team e-mail boxes and phone calls to follow up on issues
timely
. Responsible for communicating to service line partners
of
situations where rescheduling is necessary, due to lack of authorization or limited benefits.Obtains PCP referrals when applicableAlerts physician offices
I
ancillary departments to issues with obtaining pre-authorizations. Conducts diligent follow-up on missing or incomplete pre-authorizations with third-party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as neededQualifications
Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashionAbility to communicate professionally and effectively, both verbally and writtenAbility to adapt in ever changing healthcare environmentAbility to follow complex instructions and procedures, with a close attention to detail•Adheres to government guidelines such as CMS, EMTALA, and HIPAA and AdventHealth corporate
policiesAdvanced understanding of insurance knowledge and benefits•Advanced understanding of hospital electronic medical record (EMR)
system•Basic medical
terminologyEDUCATION AND EXPERIENCE REQUIRED
:High School Grad or Equivalent. 2+
years' experienceOne (1) year experience in Oncology related business operations withinspecialty pharmacy or insurance verification, payor reimbursement guidelines, and/or authorization submission. Familiarity with medical terminology and concepts. Working knowledge with third party insurance
administrators
authorization and clinical care processes.One year of direct Patient Access experienceOne year of customer service experienceHigh School diploma or GEDEDUCATION AND EXPERIENCE PREFERRED:Two years of direct Patient Access
experienceMedical AssistantLICENSURE, CERTIFICATION OR REGISTRATION
PREFERRED
:Certified Healthcare Access Associate (CHAA)Certified Revenue Cycle Representative (CRCR)Job
Organization
Organization
:
UChicago Medicine AdventHealth Great Lakes
#J-18808-Ljbffr