Authorization Counselor

adventhealth; Parker (CO); On-site; USD 29,000 - 47,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Paid Time Off

403-B Retirement Plan

Parental leave

Career development

Well-being resources

Mental health resources

Pet benefits

Job summary

AdventHealth in Parker, Colorado is seeking a skilled healthcare payer coordinator to monitor queues, verify prior authorizations, and document in Epic. You’ll obtain treatment information, communicate with providers, and estimate patient costs based on benefits and protocol.

The role requires health care experience, knowledge of ICD-10/CPT coding, strong customer service, and proficiency with computer systems; Epic knowledge is a plus. Competitive daytime schedule, full-time with benefits.

Qualifications

• Medical terminology is required.
• Insurance eligibility and verification experience is required.
• Minimum of 1 year health care experience is required.
• Knowledge of ICD-10 and CPT coding is required.
• Good customer service skills are required.
• Computer skills and willingness to use technology are required.
• Epic knowledge is preferred.

Responsibilities

• Monitor work queues for unauthorized and expiring medication-based referrals.
• Verify prior authorization requirements based on the patient’s insurance.
• Obtain clinical and treatment information from the patient’s chart.
• Submit documentation for prior authorization requests and track status.
• Coordinate with providers and teams to communicate authorization status.
• Document authorization information in the EMR (Epic).
• Provide patient cost estimates based on treatment protocol and benefits.

Skills

Medical terminology

Insurance eligibility

Health care experience

ICD-10 and CPT coding

Customer service

Computer skills

Epic knowledge

Education

Associate

Bachelor's

High School Grad or Equiv

Tools

Epic

Job description

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.

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
• Pet Benefits

Schedule: Full time

Shift: Day (United States of America)

Address: 9403 Crown Crest Blvd

City: Parker

State: Colorado

Postal Code: 80138

Job Description: Monitors work queues for unauthorized and expiring medication-based referrals. Verifies prior authorization requirements based on the patient’s specific insurance provider. Obtains clinical and treatment/therapy information from the patient’s chart. Submits clinical documentation with prior authorization requests and tracks authorization status. Schedules peer-to-peer or appeal as needed. Documents authorization information in Epic EMR. 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. Provides patient cost estimates based on specific treatment protocol and patient benefits. Monitors the schedule for self-pay patients and prepares estimates. Communicates the amount due at the time of service with the patient and patient service representatives. Coordinates patient care with third-party copay and free drug assistance vendors. Addresses patient and clinic billing questions and concerns, routing patient concerns to Revenue Management and Billing departments. Maintains good working knowledge of chemotherapy authorization requirements for all payers, state and federal regulatory guidelines for coverage and authorizations. Other duties as assigned.

Knowledge, Skills, and Abilities:

• Medical terminology [Required]
• Insurance eligibility and verification [Required]
• Minimum of 1 year health care experience [Required]
• Knowledge of ICD 10 and CPT coding [Required]
• Good customer service skills. [Required]
• Computer skills and willingness to use technology. [Required]
• Understanding of various hematologic and oncologic conditions and malignancies. [Preferred]
• Understanding of treatments used to treat various oncologic and hematologic conditions. [Preferred]
• Knowledge of registration and billing [Preferred]
• Epic knowledge. [Preferred]

Education:

• Associate [Preferred]
• Bachelor's [Preferred]
• High School Grad or Equiv [Required]

Field of Study:

• N/A

Work Experience:

• Eligibility, billing, coding, registration experience [Preferred]
• Health care or pharmaceutical experience [Preferred]
• Previous HBA experience [Preferred]

Physical Requirements: Physical Requirements - https://tinyurl.com/23km2677

Pay Range: $21.40 - $34.24

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.