Current jobs related to Chemotherapy Authorization Specialist - Calhoun, Georgia - AdventHealth

Overview:
As a key member of the AdventHealth team, the Infusion Benefits/Authorization Specialist plays a vital role in ensuring that patients receive the necessary authorizations and benefits for their chemotherapy treatments. This position is integral to maintaining high standards of patient care and operational efficiency.

Key Responsibilities:
The Infusion Benefits/Authorization Specialist is responsible for:

• Reviewing chemotherapy treatment orders to determine insurance benefits and authorization requirements.
• Analyzing clinical data, including pathology reports and laboratory results, to ensure compliance with insurance payor guidelines.
• Conducting utilization reviews to support authorization requests to payors or third-party administrators.
• Verifying medical necessity in accordance with CMS standards and communicating relevant coverage information to patients.
• Collaborating with service line partners to address medical necessity issues and facilitate peer-to-peer discussions with insurance providers.
• Managing pre-authorizations for chemotherapy treatments and research protocols, ensuring all documentation is accurately uploaded to electronic medical records.
• Contacting insurance companies to verify eligibility and benefits, ensuring timely authorizations prior to patient appointments.

Qualifications:
The ideal candidate will possess:

• A high school diploma or equivalent.
• At least one year of experience in oncology-related operations, including specialty pharmacy or insurance verification.
• Familiarity with medical terminology and third-party insurance processes.
• Strong customer service skills and the ability to communicate effectively with patients and healthcare providers.

Work Environment:
This position is part-time and offers a supportive work environment focused on professional growth and spiritual development. AdventHealth is committed to fostering a culture of respect and inclusivity.