Modesto & Roseville, California
Northern & Central California, California
Northern & Central California, California
Sacramento, California
Santa Clara, California
Laguna Hills, California
Northern California or REMOTE, California
Tacoma, Washington
Springfield, Massachusetts
Posted: 21-Nov-23
Location: Parker, Colorado
Salary: Open
Internal Number: 23042953
Description
All the benefits and perks you need for you and your family:
- Paid Days Off from Day Oneâ¯
- Student Loan Repayment Programâ¯
- Career Developmentâ¯â¯
- Whole Person Wellbeing Resourcesâ¯
Our promise to you:â¯â¯
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.â¯â¯
Schedule: Full-time
Shift:⯠Day
Location: 9395 CROWN CREST BLVD, Parker, 80138
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.
- 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.
- Documents authorization information, including date ranges and number of authorized units/visits in Epic EMR. Uploads approval letters into EMR Media Manager.
- 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.
The expertise and experiences you’ll need to succeed:
Required:
- High school diploma or GED required.
