Oncology infusion authorization counselor

adventhealth; Colorado; On-site; USD 29,000 - 47,000; Full time

Benefits offered by this job

Medical, Dental, Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave

Job summary

AdventHealth in Denver, Colorado is seeking an insurance verification and prior authorization specialist to support chemotherapy referrals. You will verify coverage, obtain chart information, and prepare required documentation for authorizations while coordinating with providers and billing teams.

The role requires knowledge of ICD-10/CPT coding, strong customer service, and familiarity with Epic EMR. On-site daytime hours and comprehensive benefits apply, with opportunities for growth within

Qualifications

• Medical terminology is required.
• Insurance eligibility and verification experience required.
• Minimum 1 year of health care experience required.
• Knowledge of ICD-10 and CPT coding required.
• Strong customer service and communication skills required.
• Proficiency with computer systems and willingness to use technology.
• Epic knowledge and experience preferred.
• Registration and billing knowledge preferred.
• Hematology/oncology knowledge preferred.

Responsibilities

• Monitor queues for unauthorized or expiring medication-based referrals.
• Verify prior authorization requirements with patient insurance.
• Obtain clinical and treatment information from patient charts.
• Submit documentation for prior authorizations and track status.
• Schedule peer-to-peer or appeal meetings as needed.
• Document authorization details in Epic EMR.
• Communicate authorization status with care teams and front desk.
• Provide patient cost estimates and discuss payment options.
• Coordinate care with third-party vendors for copays and assistance.
• Ensure compliance with payer guidelines and state/federal rules.
• Support additional duties as assigned.

Skills

Medical terminology

Insurance eligibility & verification

Health care experience

ICD-10 and CPT coding

Customer service

Computer skills

Epic knowledge

Registration and billing

Hematology/oncology knowledge

Education

Associate degree

Bachelor's degree

High School Diploma

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:

2525 S DOWNING ST

City:

DENVER

State:

Colorado

Postal Code:

80210

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]

Additional Information:

• N/A

Licenses and Certifications:

• N/A

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.