ONCOLOGY AUTHORIZATION SPECIALIST (FT DAYS)

Riverside Healthcare • Bourbonnais, IL

15h • $19 - $23

About The Position

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.

Requirements

• High School Diploma or equivalent required.

Nice To Haves

• 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.

Responsibilities

• Secure prior authorizations for all infusion treatments.
• Verify patient insurance coverage for planned treatments and communicate any coverage limitations or out-of-pocket costs to patients and clinical teams.
• Maintain detailed and accurate records of all authorization requests, approvals, denials, and appeals. Ensure documentation is in compliance with regulatory and organizational standards.
• Act as a liaison between patients, healthcare providers, and insurance companies to ensure clear and timely communication regarding authorization statuses.
• Manage and track authorization denials, initiating appeals when necessary, and work with providers to adjust treatment plans if needed.
• Ensure all authorization processes adhere to HIPAA regulations and other relevant laws and guidelines.
• 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.
• Provide basic education to patients regarding insurance processes and coverage, as needed. Provides appropriate copay and financial assistance information.
• Participate in process improvement initiatives to streamline authorization workflows and enhance patient experience.
• Assist with general administrative duties in the Outpatient Infusion Center as needed.

Benefits

• 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 positions 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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees