Durham, North Carolina
Springfield, Massachusetts
Posted: 13-Feb-25
Location: Denver, Colorado
Categories:
Internal Number: 25005818
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Student Loan Repayment Program
- Career Development
- Whole Person Wellbeing Resources
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-time
Shift: Days
Location: AHMG OP Center Chemo Infusion 2, 2555 S DOWNING ST, Denver, CO, 80210
The role you’ll contribute:
Monitors several WQs that capture incoming unauthorized medication orders as well as expiring medication orders. Accountable for obtaining clinical information and treatment protocol information from the patient’s medical record, while verifying if treatment is ongoing, new, or altered. After gathering clinical information, responsible for obtaining prior authorization for infusion and injectable medications based on provider orders and insurance and facility product preferences. Monitors authorization progress and communicates updates regarding insurance denial, approval, or peer to peer requirements to nursing staff, pharmacy staff, and clinic providers. If needed peer to peer is scheduled and appeals are processed and submitted in accordance with payor requirements. Utilizes scheduling and registration information to verify active insurance coverage and to verify insurance network participation, determining patient’s individual benefits and co-insurance amounts, which are transcribed into EMR medication referral and utilized to prepare estimate via EMR estimate tool. Utilizes the Department Appointment Report to attach authorized medication referrals to all infusion encounters, verifying that authorization is within authorized time period and has not exceeded allowed visits. Communicates benefit, co-insurance, and estimate amounts to infusion patients and provides all estimates for self-pay patients. Answers billing and benefits questions for patients and team members. Acts as a liaison between the patients, physicians, centralized billing office, hospital case management, Atlas drug program and AdventHealth Porter Specialty pharmacy liaisons.
The value you’ll bring to the team:
- Monitor WQs that capture unauthorized medication-based referrals as well as expiring medication-based referrals.
- Verifies Prior authorization requirements based on patient’s specific insurance provider.
- Obtains clinical and treatment/therapy information form patient’s chart.
- Submits clinical documentation along with prior authorization request and tracks authorization status, scheduling peer to peer or appeal as needed.
The expertise and experiences you’ll need to succeed:
- High school diploma or GED required.
