Benefit options and eligibility vary by position, scheduled hours and location. Benefits are subject to change at any time. Your recruiter will provide the most up-to-date details during the hiring process.
ResponsibilitiesThe Infusion Intake & Authorization Coordinator manages the end-to-end financial clearance process for high-cost specialty and infusion therapies. This role is responsible for clinical intake, insurance benefit verification, prior authorization submissions, and medical necessity validation to ensure timely patient access to care while preventing revenue leakage. Acts as a key liaison between patients, providers, payers, and internal clinical teams.
Comprehensive Lifecycle Management:
Execute end-to-end financial clearance by performing clinical intake, rigorous benefit verification, and Medical Necessity Validation (MNV) prior to payer submission.Clinical Evidence Synthesis:
Secure and organize robust clinical substantiation, including Letters of Medical Necessity (LMN), diagnostic lab results, and physician encounter notes—to ensure alignment with payer-specific medical policies and NCCN guidelines.Strategic PA Submission:
Initiate and track prior authorization requests through various payer portals (e.g., Availity, Evicore, New Century), ensuring all submissions meet \"Clean Order\" criteria (ICD-10, Ht / Wt, Labs).Proactive Authorization Monitoring:
Maintain continuous oversight of authorization statuses, expiration timelines, and re-authorization windows to prevent lapses in care or \"false approvals\" on medications that do not require PA but do require MNV.Financial Advocacy & Estimates:
Generate \"Good Faith Estimates\" for patients and coordinate with the Patient Assistance team to identify co-pay cards, foundation grants, or \"free drug\" programs for self-pay or underinsured populations.Payer Continuity & Vigilance:
Dynamically track and update patient insurance changes to ensure ongoing eligibility and alignment with shifting \"preferred drug\" lists and site-of-care requirements.Workflow Coordination:
Manage the \"Intake Work queue\" (electronic and scanned paper orders), ensuring a \"First-In, First-Out\" processing integrity while escalating \"Stat/Emergent\" requests per the national SOP.
Requires high-level organizational skills and the ability to perform \"detective work\" across multiple insurance platforms. Must be able to balance high-volume processing with extreme attention to detail to avoid high-dollar J-code denials. Within the scope of the job, critical thinking skills required, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment.
RequirementsLicensure / Certification / Registration:
One or more of the following required:Pharmacy Tech credentialed from the Pharmacy Technician Certification Board (PTCB) obtained prior to hire date or job transfer date.Pharmacy Tech credentialed from the National Healthcareer Association obtained prior to hire date or job transfer date.Education:
High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Technical degree OR 4 years of applicable cumulative job specific experience required.Additional PreferencesMinimum 2 years of experience in healthcare revenue cycle, patient access, pharmacy billing, or prior authorizations
Pharmacy Technician certification required
Preferred experience with oncology or specialty infusion authorizations, J-code billing, and Buy & Bill vs. White Bagging workflows
Strong organizational, analytical, and attention-to-detail skills; ability to work independently in a high-volume environment
Why Join Our TeamAscension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.
Equal Employment Opportunity EmployerAscension provides Equal Employment Opportunities (EEO) to all associates and applicants for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy, childbirth, and related medical conditions, lactation, breastfeeding, national origin, citizenship, age, disability, genetic information, veteran status, marital status, all as defined by applicable law, and any other legally protected status or characteristic in accordance with applicable federal, state and local laws. For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.
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