RN / Registered Nurse Infusion Authorization Specialist

Neuroscience Group has an opening for a full time 40 hours / 5 days per week RN Infusion Authorization Specialist. As an integral member of the Patient Access Team, the Infusion Authorization Specialist performs functions that are vital to the authorization, scheduling, and coordination of cares for all Infusion Patients.

For over thirty years, Neuroscience Group has provided excellent neurologic care for the Fox Valley and Northeast Wisconsin. Ours is the only medical facility in the area that combines neurosurgery, neurology, orthopedic spine surgery, interventional and non-interventional pain management, and physical therapy. Our practice has grown to over 40 providers and serves patients in nine outlying clinics scattered throughout the region. Our mission is to improve lives by providing the very best in brain, spine and pain care and we do that by living our company core values: personal care and compassion, teamwork, fiscal responsibility, continuous learning and improvement, initiative and leadership and community involvement.

RESPONSIBILITIES:

• Understands and maintains confidentiality standards in compliance with State and Federal regulations
• Adheres to strict HIPAA confidentiality standards, recognizing that even acknowledgment of privileged information is prohibited.
• Upon receiving orders from the provider,
  • Verifies and reviews all patient insurance information as it applies to the pre-authorization process,
  • Determine necessity for pre-authorization,
  • Reviews chart documentation to ensure patient meets medical policy guidelines,
  • Obtains authorization via payer website, phone or fax form depending on insurance requirements,
  • Communicates with the involved parties regarding benefit eligibility and other financial issues,
  • Notifies patients and practitioners of any services requested and/or referred that are not authorized by insurance.
  • Initiates and pursues appeals for denials as appropriate.
  • Follows up regularly on pending cases.
  • Responds to both written and oral correspondence regarding scheduling changes/cancellations in a timely and accurate manner.

• Assists with Infusion supply chain management and product ordering.
• Assists with organization of infusion refrigerated products
• When applicable, places infusion orders in patient charts.
• Submits prescriptions to specialty pharmacies.
• Reviews and completes authorization for subsequent infusion(s)
• Maintains good communication with the patient and all adjuvant teams working with infusion patients.
  • Physicians
  • Clinical service lines
  • Reimbursement and billing teams
• Enters accurate information into patients' electronic medical records.
• Answers and returns calls to patients regarding Infusion Authorization.
• Routes calls or EMR encounters to the proper teams as needed.
• Establishes and maintains working relationships with various vendors for infusion medications.
• Obtain secure access to authorization or vendor distribution portals
• Regularly attends all Neurology and staff meetings
• Perform other duties as assigned.

QUALIFICATIONS:

• Registered Nurse License
• Excellent communication and customer service skills
• Detail-oriented and strong organizational and time management skills
• Ability to multi-task and work well in a fast-paced setting
• Prior experience with EPIC preferred.
• Prior authorization experience, outpatient setting preferred.
• Previous experience with CPT and ICD-10 coding preferred.
• Team player who can also work independently.

TYPICAL PHYSICAL DEMANDS AND WORKING CONDITIONS:

• Requires frequent change in position, including bending, stooping, standing, stretching, and walking and sitting, lifting, pushing, and pulling.
• May involve lifting of up to 30-40 pounds.

BENEFITS:

At Neuroscience Group we offer a very competitive salary. In addition to great pay, we also offer the following benefits:

• No nights, No weekends, No holidays!
• Health Insurance
• Health Savings Accounts with a generous employer contribution
• Dental Insurance
• Vision Insurance
• Company paid Long Term Disability and Life Insurance
• Voluntary Life and Short-Term Disability Insurance
• Voluntary Accident and Critical Illness Insurance
• Generous PTO and Sick Banks
• 401(k) with guaranteed employer contribution, Profit Sharing, and a Cash Balance Pension Plan
• Employee Assistance Program
• Timber Rattler tickets
• Holiday party, summer picnic, and annual recognition for years of service
• Annual Employee Appreciation Day