Pediatric Endocrinology Advanced Authorization Specialist

Department:

03110 GCMG Pediatric Endocrinology and Diabetes Care: 4501 Cameron Valley Pkwy - Pediatrics: Endocrinology

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

8-5

Pay Range

$21.45 - $32.20

Major Responsibilities

• Assess time sensitive Referral Work Queues to obtain highly complex authorizations including IP/OP Chemotherapy, Radiology, specifically related to Oncology treatment plans, IP/OP Surgeries, Molecular and Genetic Laboratory Testing, specialty related PT/OT and Speech Therapy, Psychiatry, Neuro/Psych Evaluations, and Rehab evaluations.

• Manage high volume Stat request mailbox for all oncology facilities for potential life altering, high-cost treatment and procedures within a short time frame. Expected treatment within 1-3 days.

• Interpret medical records to determine initial and disease progression to prove medical necessity for ordered services and complete on-line clinical requests for advanced authorization.

• Manage Advocate Health preferred drug list (chemotherapy/immunotherapy/supportive drugs) with payors and correlate changes with oncology pharmacy.

• Manage Advocate Health drug formulary changes with authorization updates with payors.

• Review laboratory panels for Bone Marrow Biopsies to authorize Molecular Lab Studies, diagnosis specific.

• Review and address monthly denials for Chemotherapy Drugs, Molecular Labs and surgeries with payors and Advocate Health Denial Management Teams (HBO/PBO).

Minimum Job Requirements

Education

Bachelor's Degree or 3 years of authorization experience required.

Work Experience

Bachelor's Degree or 3 years of authorization experience required.

Knowledge / Skills / Abilities

• General knowledge and background in CPT and HCPCS Coding.

• Must be proficient with medical terminology and be familiar with clinical considerations as these relate to oncology services.

• Excellent written and oral communication skills required.

• Microsoft Excel, Word, Epic experience preferred.

• Databases, hospital registration, billing and clinical systems preferred.

Physical Requirements and Working Conditions

• Work requires typing, filing, use of telephone and sitting for prolonged periods of time.

• Should be able to bend and lift up to 10lbs.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

About Advocate Health 

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience