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

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support

Our promise to you:

Joining UChicago Medicine AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine 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: Monday-Friday 8am to 4:30pm

Shift: Days

Location: 1 SALT CREEK LN, Hinsdale, 60521

The community you'll be caring for: UChicago Medicine AdventHealth Bolingbrook

The role you'll contribute:

The Pre-Access Infusion Benefits and Authorization Specialist Lead, under general supervision, maintains performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens, and other injection/infusion treatments. Meet standards established by leadership for all patient services. Meets or exceeds department audit accuracy and productivity standard goal. Uses utmost caution that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test, and procedure or registration being performed. Audits accounts to ensure accuracy and provides education to team members. Handles escalations from team and clinical partners for expedited resolution. Adheres to AdventHealth Corporate Compliance Plan and to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you'll bring to the team:

• Develops and implements ongoing training programs to keep staff updated on the latest practices and technologies.
• Organizes workshops, seminars, and ongoing education for staff development; tracking and recording staff participation.
• Monitors and evaluates team performance to identify areas for improvement.
• Provides feedback and coaching to enhance staff skills and efficiency.
• Conducts regular performance reviews and sets goals for team members.
• Ensures accurate and timely processing of orders.
• Trains staff on order management systems and procedures.
• Trains staff on insurance authorization processes and requirements.
• Monitors order workflows to identify and resolve any issues.
• Reviews clinical data such as patient pathology reports, imaging, laboratory results, prior treatments, matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines.
• Responsible for communicating to service line partners when medical necessity is not met including review of journal articles, compendia and/or peer review to justify medical necessity approval.
• Monitors patient interactions to ensure high-quality care and adherence to standards.
• Ensures that all staff are trained in patient care protocols and procedures.
• Ensures that all necessary authorizations are obtained, including length of authorization; total number of visits; and/or units of medication prior to services provided.
• Addresses any patient care concerns or complaints promptly.
• Other duties as assigned.

Qualifications

The expertise and experience you'll need to succeed :

• High School Grad or Equiv Required
• Associate Preferred
• Two or more years of Work Experience Required
• Mature judgement in dealing with patients, physicians, and insurance representatives
• Intermediate knowledge of Microsoft programs and familiarity with database programs
• Ability to operate general office machines such as computer, fax machine, printer, and scanner
• Ability to effectively learn and perform multiple tasks, and organize work in a systematic and efficient fashion
• Ability to communicate professionally and effectively, both verbally and written
• Ability to adapt in ever changing healthcare environment
• Ability to follow complex instructions and procedures, with a close attention to detail
• Adheres to government guidelines such as CMS, EMTALA, and HIPAA and AdventHealth corporate policies
• Exceptional customer service skills
• Advanced understanding of insurance knowledge and benefits
• Advanced understanding of hospital electronic medical record (EMR) system
• Basic medical terminology
• Must be able to read, write, and speak conversational English
• Understanding of HIPAA privacy rules and ability to use discretion when discussing patient related information that is confidential in nature as needed to perform duties
• Intermediate medical terminology
• Certified Healthcare Access Associate (CHAA) Preferred
• Certified Revenue Cycle Rep (CRCR) Certified Revenue Cycle Representative (CRCR) Preferred

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.

Category: Patient Financial Services

Organization: UChicago Medicine AdventHealth Bolingbrook

Schedule: Full-time

Shift: 1 - Day

Req ID: 25043681

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.