ONCOLOGY AUTHORIZATION SPECIALIST (FT DAYS)

Overview

\"The Infusion Authorization Specialist at Riverside Healthcare's Ambulatory Infusion Center plays a crucial role in ensuring that patients receive timely and appropriate care by securing insurance authorizations for infusion treatments. This position involves close collaboration with clinical teams, insurance providers, and patients to navigate the complexities of insurance policies and authorization processes. The specialist is responsible for obtaining prior authorizations, verifying insurance coverage, and maintaining accurate documentation to support patient care and treatment plans

Essential Duties

• Insurance Authorization: Secure prior authorizations for all infusion treatments.
• Coverage Verification: Verify patient insurance coverage for planned treatments and communicate any coverage limitations or out-of-pocket costs to patients and clinical teams.
• Documentation Management: Maintain detailed and accurate records of all authorization requests, approvals, denials, and appeals. Ensure documentation is in compliance with regulatory and organizational standards.
• Communication: Act as a liaison between patients, healthcare providers, and insurance companies to ensure clear and timely communication regarding authorization statuses.
• Denial Management: Manage and track authorization denials, initiating appeals when necessary, and work with providers to adjust treatment plans if needed.
• Compliance: Ensure all authorization processes adhere to HIPAA regulations and other relevant laws and guidelines.
• Team Collaboration: Collaborate with the infusion team to coordinate treatment schedules based on authorization approvals and ensure seamless patient care.
• Scheduling of appointments and accurate registration for all infusion patients.
• Demonstrates flexibility with assignments within professional scope/duties/licensure.
• Adhere to AIDET format and standards. Acknowledge and greet all customers timely with a professional and friendly demeanor.
  
  

Non-essential Duties

• Patient Education: Provide basic education to patients regarding insurance processes and coverage, as needed. Provides appropriate copay and financial assistance information.
• Process Improvement: Participate in process improvement initiatives to streamline authorization workflows and enhance patient experience.
• Administrative Support: Assist with general administrative duties in the Outpatient Infusion Center as needed.\"
  
  

Responsibilities

Preferred Experience

• Strong understanding of insurance policies, authorization processes, and oncology treatment protocols.
• Knowledge of medical terminology.
• Excellent communication and interpersonal skills, with the ability to navigate complex conversations with patients, providers, and insurance companies.
• Proficiency in electronic health record (EHR) systems and other healthcare-related software.
• Detail-oriented with strong organizational skills and the ability to manage multiple tasks simultaneously.
• Knowledge of HIPAA regulations and a commitment to maintaining patient confidentiality.
  
  

Required Licensure/Education

• High School Diploma or equivalent required.
  
  

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment To You

Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so your journey at and away from work is remarkable. Our Total Rewards package includes:

Compensation

• Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift differential, on-call
• Opportunity for annual increases based on performance
  
  

Benefits - .5 To 1.0 FTE

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program
  
  

Benefits - .001 To .49 FTE

• Paid Leave Hours accrued as you work
  
  

Employee Health Requirements

Exposure/Sensory Requirements:

Exposure To

• Chemicals: Refer to MSDS sheets
• Video Display Terminals: Average
• Blood and Body Fluids: May be asked to transport blood specimens to the lab.
• TB or Airborne Pathogens: Normal
  
  

Sensory Requirements (speech, Vision, Smell, Hearing, Touch)

• Speech: Communication with patients, physicians, co-workers, and other hospital personnel as well as telephone communication.
• Vision: Needed to read memos and literature as well as computer use and filing.
• Smell: Helpful to note presence of electrical/fire safety.
• Hearing: Needed for telephone communication, meetings, alarms and listening to patient concerns.
• Touch: Needed to write, computer entry, filing.
  
  

Activity/Lifting Requirements

Percentage of time during the normal workday the employee is required to:

• Sit: 85%
• Twist: 0%
• Stand: 5%
• Crawl: 0%
• Walk: 5%
• Kneel: 0%
• Lift: 3%
• Drive: 0%
• Squat: 0%
• Climb: 0%
• Bend: 1%
• Reach above shoulders: 1%
  
  

The weight required to be lifted each normal workday according to the continuum described below:

• Up to 10 lbs: Frequently
• Up to 20 lbs: Occasionally
• Up to 35 lbs: Occasionally
• Up to 50 lbs: Not Required
• Up to 75 lbs: Not Required
• Up to 100 lbs: Not Required
• Over 100 lbs: Not Required
  
  

Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.):

Carrying patient charts - charts are lifted no higher than shoulder level.

Maximum consecutive time (minutes) during the normal workday for each activity:

• Sit: 90
• Twist: 0
• Stand: 5
• Crawl: 0
• Walk: 5
• Kneel: 0
• Lift: 1
• Drive: 0
• Squat:0
• Climb: 0
• Bend: 0
• Reach above shoulders: 1
  
  

Repetitive Use Of Hands (Frequency Indicated)

• Simple grasp up to 10 lbs. Normal weight: 5- 10# often
• Pushing &pulling Normal weight: 5-200#
• Fine Manipulation: Computer keyboard, calculator, writing
  
  

Repetitive use of foot or feet in operating machine control: None

Environmental Factors & Special Hazards

Environmental Factors (Time Spent):

• Inside hours: 8
• Outside hours : 0
• Temperature: Normal Range
• Lighting: Average
• Noise levels: Average
• Humidity: Normal Range
• Atmosphere: Dust
  
  

Special Hazards: None

Protective Clothing Required: None

Pay Range

USD $18.83 - USD $23.00 /Hr