Prea Infben - Orlando, United States - AdventHealth Orlando

AdventHealth Orlando

Verified Company

Orlando, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

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
Mental Health Resources and Support

Pet Insurance

Debtfree Education* (Certifications and Degrees without outofpocket tuition expense)

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/Part Time

Shift:
Day

Location:
Orlando Sup

The community you'll be caring for:

Orlando South: 601 E Rollins St Suite 400, Orlando, FL 32803

Located on a lush tropical campus, our flagship hospital, 1,368bed AdventHealth Orlando

- serves as the major tertiary facility for much of the Southeast, the Caribbean and South America

AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country
We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year

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:

Responsible for review of chemotherapy regimen/treatment orders and determines insurance benefits and authorization requirements. 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. Ensures specified medical terms, diagnosis, medication codes and supporting clinical documentations are met. Utilization review to facilitate the sending of clinical information in support of the authorization to payor or third-party administrators, as assigned.
Reviews medical records in detail to confirm the treatment is supported by approved medical studies by reputable oncology/hematology studies. Stays current on payer preference for biosimilar drugs available. Ensures patient orders are changed accordingly if biosimilar drug is preferred. Ensures that each treatment is coded, reviewed, and financially cleared based on the patient insurance requirements.
Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards by reviewing guidelines and communicates relevant coverage/eligibility information to the patient. Alerts physician offices to issues with verifying insurance. 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. Escalates peer to peer (insurance company physician requests to speak to ordering physician) requests to physician offices and assists in scheduling peer to peer requests with the office and the payer to ensure an authorization decision is made prior to date of service.
Obtains initial and subsequent preauthorization for chemotherapy treatments, as well as research protocols, on all new and existing patients and notes approvals in the electronic medical record. Uploads treatment supporting documentation packet to the electronic medical record for Revenue Cycle billing and coding teams.
Contacts insurance companies by phone, fax, online portal, and other resources to obtain and verify insurance eligibility and benefits and determine extent of coverage within established timeframe before scheduled appointments and during or after care for unscheduled patients
Obtains preauthorizations from thirdparty payer