Authorization Counselor

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

Job summary

AdventHealth in Parker, Colorado seeks a healthcare authorization specialist to monitor medication referrals, verify insurance, and obtain chart data for prior authorization requests. You will submit documentation and track approval status in Epic EMR, coordinating with providers, nursing, pharmacy, and billing teams.

The role involves communicating patient cost estimates, verifying coverage, and assisting with self-pay scheduling while ensuring compliance with state and federal guidelines and

Qualifications

• Must have medical terminology knowledge and insurance verification experience.
• At least 1 year health care experience and knowledge of ICD-10/CPT coding.
• Customer service skills required and computer proficiency with willingness to use technology.
• Knowledge of hematologic and oncologic conditions and treatments preferred.
• Epic knowledge and registration/billing familiarity preferred.

Responsibilities

• Monitor work queues for unauthorized and expiring medication-based referrals.
• Verify prior authorization requirements based on patient insurance.
• Obtain clinical and treatment information from patient charts.
• Submit clinical documentation with prior authorization requests and track status.
• Schedule peer-to-peer or appeal as needed.
• Document authorization information in Epic EMR.
• Communicate insurance and facility products and authorization status with providers and teams.
• Verify insurance coverage, benefits, and network status.
• Provide patient cost estimates based on treatment protocol and benefits.
• Coordinate patient care with third-party copay and free drug vendors.
• Address patient and clinic billing questions with Revenue Management and Billing.
• Maintain knowledge of chemotherapy authorization requirements for payers and regulatory guidelines.

Skills

Medical terminology

Insurance eligibility

Healthcare experience

ICD-10/CPT coding

Customer service

Computer skills

Hematologic oncology knowledge

Oncology treatments understanding

Registration & billing

Epic knowledge

Education

Associate degree

Bachelor's degree

High school diploma

Tools

Epic knowledge

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:

(Please click the link below to view work 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.