PreAccess Oncology Benefits and Authorization Specialist

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.

All the benefits and perks you need for you and your family:

• Benefits from Day One: 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

Schedule:

Full time

Shift:

Day (United States of America)

Address:

900 WINDERLEY PL

City:

MAITLAND

State:

Florida

Postal Code:

32751

Job Description:

Alerts physician offices to issues with verifying insurance and communicates situations where medical necessity is not met. Reviews clinical records when following up on authorization requests directly with payors. Obtains initial and subsequent pre-authorizations for chemotherapy treatments and research protocols, noting approvals in the electronic medical record. Contacts insurance companies to obtain and verify insurance eligibility and benefits within established timeframes. Other duties as assigned. Reviews chemotherapy regimen/treatment orders and determines insurance benefits and authorization requirements. Reviews clinical data such as patient pathology reports, scans, laboratory results, and prior treatments against insurance payor and most appropriate guidelines. Reviews clinical data such as patient pathology reports, scans, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines. 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 approval Reviews clinical records when following up on authorization request directly with a payor. Ensures specified medical terms, diagnosis, medication codes, and supporting clinical documentation are met. Facilitates the sending of clinical information in support of authorization to payor or third-party administrators. Reviews medical records to confirm treatment is supported by approved medical studies. Stays current on payer preferences for biosimilar drugs and ensures patient orders are updated accordingly. Ensures each treatment is coded, reviewed, and financially cleared based on patient insurance requirements. Verifies medical necessity in accordance with CMS standards and communicates relevant coverage/eligibility information to patients.

Knowledge, Skills, and Abilities:
• Mature judgement in dealing with patients, physicians, and insurance representatives [Required]
• Intermediate knowledge of Microsoft programs and familiarity with database programs [Required]
• Ability to operate general office machines such as computer, fax machine, printer, and scanner [Required]
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion [Required]
• Ability to communicate professionally and effectively, both verbally and written [Required]
• Ability to adapt in ever changing healthcare environment [Required]
• Ability to follow complex instructions and procedures, with a close attention to detail [Required]
• Adheres to government guidelines such as CMS, EMTALA, and HIPAA and corporate policies [Required]
• Exceptional customer service skills [Required]
• Advanced understanding of insurance knowledge and benefits [Required]
• Advanced understanding of hospital electronic medical record (EMR) system [Required]
• Basic medical terminology [Required]
• Must be able to read, write, and speak conversational English [Required]
• Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature as needed to perform duties [Preferred]
• Intermediate medical terminology [Preferred]
• Bilingual – English/Spanish [Preferred]

Education:
• High School Grad or Equiv [Required]

Field of Study:
• Medical Billing Claims Specialist Course

Work Experience:
• 1+ customer service [Preferred]
• 1+ direct patient access [Preferred]
• 1+ oncology revenue cycle experience [Preferred]

Additional Information:
• N/A

Licenses and Certifications:
• Pharmacy Technician - Provisional (PHT-PROV) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$17.63 - $28.20

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.