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

Our promise to you:

Joining UChicago Medicine AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine 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: Monday-Friday from 8am to 4:30pm

Shift: Days

Location: 120 North Oak Street, Hinsdale, IL 60521

The community you'll be caring for: UChicago Medicine AdventHealth Hinsdale

The role you'll contribute:

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

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Patient Financial Services

Organization: UChicago Medicine AdventHealth Hinsdale

Schedule: Full-time

Shift: 1 - Day

Req ID: 25043288

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.