Oncology Infusion Authorization Counselor

About the role

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.

Located at 2525 S Downing St, Denver, CO 80210.

Responsibilities

• Monitors work queues for unauthorized and expiring medication-based referrals.
• Verifies prior authorization requirements based on the patient’s specific insurance provider.
• Obtains clinical and treatment/therapy information from the patient’s chart.
• Submits clinical documentation with prior authorization requests and tracks authorization status.
• Schedules peer-to-peer or appeal as needed.
• Documents authorization information in Epic EMR.
• Communicates insurance and facility preferred products and authorization status with providers, nursing team, pharmacy team, front desk, and MA team.
• Verifies insurance coverage, benefits, and network status.
• Provides patient cost estimates based on specific treatment protocol and patient benefits.
• Monitors the schedule for self-pay patients and prepares estimates.
• Communicates the amount due at the time of service with the patient and patient service representatives.
• Coordinates patient care with third-party copay and free drug assistance vendors.
• Addresses patient and clinic billing questions and concerns, routing patient concerns to Revenue Management and Billing departments.
• Maintains good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorizations.
• Performs other duties as assigned.

Requirements

• Medical terminology (Required)
• Insurance eligibility and verification (Required)
• Minimum of 1 year health care experience (Required)
• Knowledge of ICD 10 and CPT coding (Required)
• Good customer service skills (Required)
• Computer skills and willingness to use technology (Required)
• High School Graduate or Equivalent (Required)
• Associate degree (Preferred)
• Bachelor's degree (Preferred)
• Understanding of various hematologic and oncologic conditions and malignancies (Preferred)
• Understanding of treatments used to treat various oncologic and hematologic conditions (Preferred)
• Knowledge of registration and billing (Preferred)
• Epic knowledge (Preferred)
• Work experience in eligibility, billing, coding, registration (Preferred)
• Health care or pharmaceutical experience (Preferred)
• Previous HBA experience (Preferred)

Benefits

• Medical, Dental, Vision Insurance
• Life Insurance
• Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Pay

Pay Range: $21.40 - $34.24 per hour

Schedule

Full-time, Day shift