Preaccess Oncology Benefits Jobs

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 treatments, and meeting 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: 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.

Qualifications The expertise and experience you'll need to succeed : High School Grad or Equiv Required One or more years of Work Experience Required Needs to have Healthcare and Insurance experience Epic is a plus Mature judgement in dealing with patients, physicians, and insurance representatives Intermediate knowledge of Microsoft programs and familiarity with database programs Ability to operate general office machines such as computer, fax machine, printer, and scanner Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion Ability to communicate professionally and effectively, both verbally and written Ability to adapt in ever changing healthcare environment Ability 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 policies Exceptional customer service skills Advanced understanding of insurance knowledge and benefits Advanced understanding of hospital electronic medical report (EMR) system Basic medical terminology Must be able to read, write, and speak conversational English 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 Intermediate medical terminology Bilingual English/Spanish Pharmacy Tech - Provisional (PHATP) Preferred Certified Revenue Cycle Rep (CRCR) Preferred

• Obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens and treatments, and meeting standards established by leadership for all patient services.
• Meeting or exceeding department audit accuracy and productivity standard goal.
• Using utmost caution that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test, and procedure or registration being performed.
• Adhering to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
• Actively participating in outstanding customer service and accepting responsibility in maintaining relationships that are equally respectful to all.
• 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.
• 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.
• 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.

• High School Grad or Equiv Required
• One or more years of Work Experience Required
• Needs to have Healthcare and Insurance experience
• Epic is a plus
• Mature judgement in dealing with patients, physicians, and insurance representatives
• Intermediate knowledge of Microsoft programs and familiarity with database programs
• Ability to operate general office machines such as computer, fax machine, printer, and scanner
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
• Ability to communicate professionally and effectively, both verbally and written
• Ability to adapt in ever changing healthcare environment
• Ability 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 policies
• Exceptional customer service skills
• Advanced understanding of insurance knowledge and benefits
• Advanced understanding of hospital electronic medical report (EMR) system
• Basic medical terminology
• Must be able to read, write, and speak conversational English
• 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
• Intermediate medical terminology
• Bilingual English/Spanish
• Pharmacy Tech - Provisional (PHATP) Preferred
• Certified Revenue Cycle Rep (CRCR) Preferred

• 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

Founded in 1904, UChicago Medicine AdventHealth Hinsdale is DuPage County's only teaching hospital. Conveniently located in the heart of Chicago’s western suburbs, the 261-bed medical center provides expert, compassionate, faith-based care in the Adventist tradition to patients at all stages of their lives. UChicago Medicine AdventHealth Hinsdale has earned a number of nationally recognized awards and safety grades, particularly for its state-of-the art cancer center, Level III perinatal services with neonatal intensive care unit (NICU), pediatric-approved emergency room, and surgical capabilities that include da Vinci™ Robotic Assisted Surgery. Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.