Healthcare Authorization Specialist

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

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