Auth Spec Fin Counselor Denver, CO

AdventHealth Avista

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Internal Employees Apply Here

• Job Schedule: Full-time
• Pay Range: $21.19 - $33.9 per hour
• Job ID: 25022758
• Job Family: Patient Financial Services
• Shift: 1 - Day
  
  

AdventHealth Avista in Louisville, Colorado is a comprehensive medical center that provides a full range of medical specialties and exceptional health care to the Louisville, Superior, Broomfield and surrounding Boulder area communities. A 114-bed full-service hospital, Avista provides first-rate Heart and Vascular and emergency care. Avista is home to a Joint and Spine Care Center specializing in hip and knee replacement and spine surgery. It is also widely recognized for its award-winning New Life Center, the Louisville and Boulder area's largest and most innovative birth center and home of the area’s largest Neonatal Intensive Care Nursery.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Student Loan Repayment Program
• Career Development
• Whole Person Wellbeing Resources
  
  

Schedule: Full-time

Shift : Days

Location: AHMG OP Center Chemo Infusion 2, 2525 S DOWNING ST, Denver, 80210

The Role You’ll Contribute

Monitors several WQs that capture incoming unauthorized medication orders as well as expiring medication orders. Accountable for obtaining clinical information and treatment protocol information from the patient’s medical record, while verifying if treatment is ongoing, new, or altered. After gathering clinical information, responsible for obtaining prior authorization for infusion and injectable medications based on provider orders and insurance and facility product preferences. Monitors authorization progress and communicates updates regarding insurance denial, approval, or peer to peer requirements to nursing staff, pharmacy staff, and clinic providers. If needed peer to peer is scheduled and appeals are processed and submitted in accordance with payor requirements. Utilizes scheduling and registration information to verify active insurance coverage and to verify insurance network participation, determining patient’s individual benefits and co-insurance amounts, which are transcribed into EMR medication referral and utilized to prepare estimate via EMR estimate tool. Utilizes the Department Appointment Report to attach authorized medication referrals to all infusion encounters, verifying that authorization is within authorized time period and has not exceeded allowed visits. Communicates benefit, co-insurance, and estimate amounts to infusion patients and provides all estimates for self-pay patients. Answers billing and benefits questions for patients and team members. Acts as a liaison between the patients, physicians, centralized billing office, hospital case management, Atlas drug program and AdventHealth Porter Specialty pharmacy liaisons.

The Value You’ll Bring To The Team

• Monitor WQs that capture unauthorized medication-based referrals as well as expiring medication-based referrals.
• Verifies Prior authorization requirements based on patient’s specific insurance provider.
• Obtains clinical and treatment/therapy information form patient’s chart.
• Submits clinical documentation along with prior authorization request and tracks authorization status, scheduling peer to peer or appeal as needed.
  
  

Required Qualifications

The expertise and experiences you’ll need to succeed:

• High School Grad or Equiv
  
  

Preferred Qualifications

• Associate
• Bachelor's
• Related Experience
  
  

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

Category: Patient Financial Services

Organization: AdventHealth Avista

Schedule: Full-time

Shift: 1 - Day

Req ID: 25022758

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

Apply Now

Apply Now

Internal Employees Apply Here

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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.