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
• Mental Health Resources and Support
• Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

 

 

 

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.

Schedule:  Full Time

Shift: Monday - Friday 8:00am - 5:00pm 

Location: 601 EAST ROLLINS STREET, Orlando, 32803

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

· Accountable for day-to-day functions of infusion oncology benefits and authorization team operations. Implements, supervises, and monitors region wide processes related to financial clearance including eligibility and verification of benefits, and pre-authorization of services to ensure Financial Clearance is achieved prior to a patient being scheduled and a minimum of 7 days out from expected

date of service. Identifies problems proactively and seeks immediate resolution to ensure patient care is not impacted.

· Directly responsible for employee engagement and ensuring team huddles occur and relevant updates are shared with team. Solicits feedback from team on ideas to improve process flows or any additional training/education that may be needed. Develops action plan in collaboration with direct manager to ensure employee engagement is a top focus. Responsible for checking in with team members at a regular cadence to provide mentorship, resolve issues, and ensure performance is reviewed according to policy. Is readily available to staff and Lead in person or by phone to answer questions and resolve issues.

· Accountable for mitigating initial denials and write off denials. Tracks and trends denials and identifies payer issues and works with billing and managed care as appropriate as well as identifies continuing education needs and coordinates with team leads to deliver education to team to ensure all authorizations are obtained accurately and timely. Creates action plans for performance for team members and coaches’ team to meet and exceed goals.

· Audits performance and provides education to front line staff in order to maintain or exceed accuracy level standards. Provides constructive feedback that motivates the team and enhances knowledge to assist in meeting accuracy standard goals, minimize department registration errors, rejections, and avoidable denials. Specifically audits to ensure direct reports obtain authorization approval dates, correct CPT Codes, and determine if regimen is within guidelines as well as verifies any other items to aide in reduction of avoidable denials and write offs.

· Serves as single point of contact for initial communication with service partners inclusive of medical group, managed care, ancillary, and support departments and is the first stage of the escalation process to leadership. Escalates high-priority accounts with missing authorization or limited benefits to leadership and escalates when treatment is outside of guidelines to appropriate clinical personnel to determine if articles of compendia/peer reviewed articles may be needed to prove reasoning for treatment.

· Maintains a close working relationship with clinical partners and financial advocate team to ensure continual open communication between clinical, ancillary, and Patient Access and Patient Financial Services Departments. Contacts physicians and/or Case Management/Utilization Review to facilitate the sending of clinical information in support of the authorization to the payor.

· Maintains a current and thorough knowledge of utilizing online and system tools available. Provides authorization statuses accordingly by notifying physicians and/or clinical areas. Maintains sign on access to online tools in order to provide consistent service to patients, clinical partners, and revenue cycle team members.

· Handles patient inquiries and complaints from administration, management, and staff on a continual basis to resolve concerns regarding Financial Clearance operations. Ensures timely intervention when a need is indicated and provides follow through on a resolution that meets our core business philosophies.

· Maintains knowledge of all account segmentation to ensure all efforts follows a set schedule to accomplish business objectives. Reports all incidents regarding payor related issues for trending purposes and ensures known issues are reported to the appropriate personnel, accordingly.

· Generates, manages, and distributes authorization trend reports to provide statistical evidence to performance goals are met consistently.

· Handles department complaints and patient survey statistics. Interacts and intervenes on incidents that require supervisor handling to prevent escalated matters. Ensures quality assurance is met by coordinating with education department via call sampling for all staff on a continual basis to promote positive patient experience.

· Presents written and verbal directions to employees to ensure well-informed status of employees in performance of their job requirements as indicated.

· Works with Talent Acquisition for staffing needs. Oversees new hire training to successfully meet 90-day productivity standards.

· Ensures team success in meeting and exceeding stated monthly KPIs to protect financial standing of AdventHealth, by holding staff accountable for individual goals set by corporate and department leadership.

· Responsible for coordinating and setting up schedules for team members’ training and education sessions. Monitors team time and attendance according to policy, flexing as needed and reducing costs where applicable.

· Responsible for addressing progressive counseling according to policy.

· Identifies problems proactively for expedited resolution. Initiates and assumes responsibility for new tasks independently as appropriate and as delegated

· Maintains skill level and knowledge by reading updates, attending training sessions and completing study materials as needed. Completes department competencies as required and ensures staff complete competencies by the due date.

· Performs other duties as assigned

Qualifications

KNOWLEDGE AND SKILLS REQUIRED:

· Ability to use discretion when discussing personnel/patient related issues that are confidential in nature and act accordingly

· Ability to respond to ever-changing matrix of hospital needs and act accordingly

· Excellent telephone etiquette, listening skills, and problem solving techniques

· Detail oriented and adaptability

· Self-motivated quick thinker with the ability to deal with a high volume of patient complaints

· Proficiency in performance of basic math functions,

· Ability to communicate professionally, verbally and in writing

· Knowledge of payor and/or NCCN or applicable guidelines

KNOWLEDGE AND SKILLS PREFERRED:

· None

EDUCATION AND EXPERIENCE REQUIRED:

· Associate’s degree OR two years of experience as a Medical Assistant, Pharmacy Tech, or direct Patient/PreAccess experience or related field

· One year of experience in Oncology related business operations within specialty pharmacy, insurance verification, payor reimbursement guidelines, and/or authorization submission

· One year of experience as team lead or supervisor

EDUCATION AND EXPERIENCE PREFERRED:

· Bachelor’s degree in business, healthcare administration, finance, accounting, marketing, related field

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

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