Default Work Shift:
Day (United States of America)
Hours:
40
Salary range:
$19.72 - $29.95
Schedule:
Full Time
Shift Hours:
8 Hour employee
Department:
Administration (ELCCC)
Job Objective:
Under the supervision of the Business Office Manager, submits requests for medication authorization to insurance companies and provides documentation to support complex infusion treatments. Education:
Required: High school diploma, GED or higher level degree
Licensure/Certification:
N/A
Experience:
Preferred: Experience reviewing medication authorizations in a medical office; experience working with EMR systems; experience in oncology Reports To: Business Office Manager, Multiple Service Lines
Supervises: N/A
Ages of Patients: Adult, Geriatric
Blood Borne Pathogens: Minimal/ No Potential
Skills, Knowledge, Abilities:
Ability to effectively communicate and write clearly, Exceptional customer service skills, Insurance knowledge, both government and commercial, Self-starter; driven to take action without needing prompting, Strong computer skills
Essential Responsibilities
1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
2. Ensures the accurate and timely processing of injection and infusion orders.
3. Works with third-party insurance representatives and EMC clinical staff to process prior authorization requests for infusions and injections.
4. Obtains required clinical documentation for prior authorization (ex: progress notes, labs, diagnoses codes, previous therapies, etc.), ensuring all needed clinical records are collected in order to have treatment authorized on the first attempt.
5. Reviews authorization queue for orders and makes sure the schedule is clear for the coming days.
6. Observes payor contractual authorization requirements.
7. Utilizes website portals and electronic options (when available) to submit authorization requests. Employs other communication sources when required by the payor.
8. Works with management to identify payor trends, preferred medications, biosimilars and/or generics.
9. Performs other duties as assigned.
There's no better place to live, work, play, and prosper. At our award-winning medical facilities located in the Coachella Valley, you'll be part of a five-star team with other top health care professionals.
In 2024, we were honored to be named to Forbes' prestigious America's Best Employers List for the third time, a testament to our dedication to providing an exceptional work environment. Eisenhower Health is the sole employer in the Coachella Valley to receive this esteemed designation, solidifying our reputation as an outstanding place to build a career.
Our dedication to delivering high-quality, compassionate medical care is evident in our rankings. According to U.S. News & World Report, we hold the esteemed position of #1 in the Inland Empire and #12 in California among hospitals. Our Magnet recognition underscores our commitment to nursing excellence and quality patient care.
Our commitment to excellence extends beyond awards; we are the only hospital in Riverside County to have received a five-star rating three years in a row in the USA Government Rating System, a distinction awarded to just 10% of hospitals nationwide.
We take pride in fostering an inclusive environment for all. With a score of 95 out of 100, we have been designated as an "LGBTQ+ Healthcare Equality Top Performer" by the Human Rights Campaign, highlighting our dedication to providing compassionate care to all members of our community.
Our commitment to patient safety is unwavering, as demonstrated by our "A" grade in the Leapfrog Hospital Safety Grade for Spring 2023.
At Eisenhower Health, we don't just set standards; we raise them. Join our team and be part of an organization that is consistently recognized for excellence in health care and workplace satisfaction. Your career at Eisenhower Health will be marked by growth, innovation, and the opportunity to make a meaningful impact on the lives of our patients and the community we serve. Eisenhower Health is an EEO.
