PreAccess Oncology Benefits/Auth Special

AdventHealth; Orlando (FL); On-site; USD 25,000 - 39,000; Full time

Benefits offered by this job

Benefits from Day One: Medical, Dental

Paid Time Off from Day One

403-B Retirement Plan

Parental Leave

Job summary

AdventHealth in Orlando, FL is seeking a medical billing specialist to verify insurance, obtain pre-auths for chemotherapy, and communicate payor requirements. You will review clinical data and ensure coding aligns with CMS and NCCN guidelines, coordinating with service lines to confirm medical necessity.

The role requires strong communication, accuracy, and experience in the oncology revenue cycle, with a focus on timely authorization and benefits verification for patients.

Qualifications

• High School Diploma or equivalent required.
• Field of study: Medical Billing/Claims course.
• 1+ year in customer service or direct patient access preferred.
• Oncology revenue cycle experience preferred.
• Provisional Pharmacy Technician license preferred.
• CRCR certification preferred.

Responsibilities

• Alert physician offices to issues with verifying insurance and communicates situations where medical necessity is not met.
• Review clinical data such as patient pathology reports, scans, lab results, and prior treatments against insurance payor guidelines.
• Obtain initial and subsequent pre-authorizations for chemotherapy treatments and research protocols.
• Verify insurance eligibility and benefits within established timeframes.

Skills

Mature judgement

MS Office

Office equipment

Multitasking

Professional communication

Healthcare environment knowledge

HIPAA compliance

Customer service

Insurance knowledge

EMR systems

English proficiency

Education

High School Diploma

Medical Billing Claims Specialist Course

Tools

MS Office

EMR system

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:

601 E Rollins St

City:

Orlando

State:

Florida

Postal Code:

32803

Job Description:

Alerts physician offices to issues with verifying insurance and communicates situations where medical necessity is not met. Reviews clinical records when following up on authorization requests directly with payors. Obtains initial and subsequent pre-authorizations for chemotherapy treatments and research protocols, noting approvals in the electronic medical record. Contacts insurance companies to obtain and verify insurance eligibility and benefits within established timeframes. Other duties as assigned. Reviews chemotherapy regimen/treatment orders and determines insurance benefits and authorization requirements. Reviews clinical data such as patient pathology reports, scans, laboratory results, and prior treatments against insurance payor and most appropriate guidelines. 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. 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. Ensures specified medical terms, diagnosis, medication codes, and supporting clinical documentation are met. Facilitates the sending of clinical information in support of authorization to payor or third-party administrators. Reviews medical records to confirm treatment is supported by approved medical studies. Stays current on payer preferences for biosimilar drugs and ensures patient orders are updated accordingly. Ensures each treatment is coded, reviewed, and financially cleared based on patient insurance requirements. Verifies medical necessity in accordance with CMS standards and communicates relevant coverage/eligibility information to patients.

Knowledge, Skills, and Abilities:

• Mature judgement in dealing with patients, physicians, and insurance representatives [Required]
• Intermediate knowledge of Microsoft programs and familiarity with database programs [Required]
• Ability to operate general office machines such as computer, fax machine, printer, and scanner [Required]
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion [Required]
• Ability to communicate professionally and effectively, both verbally and written [Required]
• Ability to adapt in ever changing healthcare environment [Required]
• Ability to follow complex instructions and procedures, with a close attention to detail [Required]
• Adheres to government guidelines such as CMS, EMTALA, and HIPAA and corporate policies [Required]
• Exceptional customer service skills [Required]
• Advanced understanding of insurance knowledge and benefits [Required]
• Advanced understanding of hospital electronic medical record (EMR) system [Required]
• Basic medical terminology [Required]
• Must be able to read, write, and speak conversational English [Required]
• Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature as needed to perform duties [Preferred]
• Intermediate medical terminology [Preferred]
• Bilingual – English/Spanish [Preferred]

Education:

• High School Grad or Equiv [Required]

Field of Study:

• Medical Billing Claims Specialist Course

Work Experience:

• 1+ customer service [Preferred]
• 1+ direct patient access [Preferred]
• 1+ oncology revenue cycle experience [Preferred]

Licenses and Certifications:

• Pharmacy Technician - Provisional (PHT-PROV) [Preferred]
• Certified Revenue Cycle Rep (CRCR) [Preferred]

Physical Requirements:

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

Pay Range:

$17.80 - $28.48

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida's background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

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