Pre-Access Oncology Specialist, Patient Access, UofL Health-UofL Hospital, First Shift, Full-time

Overview

WE ARE HIRING!

Location: 530 S. Jackson St., Louisville

 

Louisville, Kentucky 40202

 

Shift: 1st Shift Days 

 

About Us

UofL Health is a fully integrated regional academic health system with seven hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehabilitation Institute and the Brown Cancer Center.

 

With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

 

Our Mission

As an academic health care system, we will transform the health of the communities we serve through compassionate, innovative, patient-centered care.

 

Job Summary

The Pre-Access Oncology Specialist will be responsible for verifying accurate insurance, obtaining, or verifying authorization, referrals, or precertification, checking medical necessity, refers concerns about patient estimates to financial clearance team, keeping open conversations with patient and patient’s advocate for inpatient and outpatient procedures.

The Pre-Access Oncology Specialist will coordinate patient orders received from physician offices and internal ancillary departments assuring appropriate distribution to the servicing department. Reviews 100% of all scheduled procedure orders for accuracy including physician signature, test/procedure to be performed, date and diagnosis, calls physician office to clarify order as needed, and indexes order to the account.

Coordinate patient encounter utilizing multiple system applications: various registration applications, clinical operating systems, eligibility verification systems, medical necessity applications, scanning repository.

Responsibilities

• Contacts insurance plans/payers to determine eligibility and obtain coverage and benefit information. Pre-Access Oncology Specialist are to start cases over the phone, follow up, provide, and fax any clinical notes pertaining to the case to the insurance payors.
• Meets or exceeds productivity standards in the completion of daily assignments and accurate production.
• Makes changes to demographic information as necessary to produce a clean patient statement.
• Maintains consistent communication with payers, obtains any necessary referrals, treatment approvals for BMT, Med Oncology and Rad Oncology. Obtain approvals for Inpatient and Outpatient services.  Provides specifically requested information to payer to obtain approvals/authorizations; assists in the preparation of appeals for denials received from Med Oncology, Rad Oncology and/or Pharmacy.
• Document findings thoroughly and accurately and enters all authorizations that are obtain into billing system along with the correct ICD-10 and CPT code to ensure payment. This includes any add on procedures for same or next day services. Also adds authorization in electronic medical record.
• Provide Utilization Review, Admissions, University Medical Associates, and Diagnostic Radiology with all necessary referral/authorizations and any additional medical information relating to the patient.
• Assists admissions/billing departments with any insurance updates, concerns, and denials.
• Request and follow up with any retro/appeal to obtain payment.
• When procedures are changed by requesting provider, Pre-Access Oncology Specialist calls insurance payers to obtain, change or update approvals in a timely manner to take care of the patient. This will increase patient satisfaction and health of the patient.
• Pre-Access Oncology Specialist provides clinical information over the phone to nurse reviewer to prevent peer to peer reviews. If a peer-to-peer review is needed, Pre-Access Oncology Specialist will call payer to schedule.  Physicians, and physician’s nurse will be notified.  Case number with date and time are provided to the physician for peer-to-peer review.  
• Understands payer processes for intravenous medication/infusion authorizations and improves/maintains oncology compliance with payer policies and procedures.
• Verifies benefits for patients with intravenous medications/infusions ordered by Medical Oncologists. Notifies patient if benefits are not in-network.  Refers patient to an in-network facility if necessary.  Works closely with admissions and the business office as needed to accept out-of-network benefits when possible.
• When necessary, Pre-Access Oncology Specialists called the insurance company to initiate a Gap Exemption approval and obtain approval before p