Infusion Authorization Advocate

Location: Remote

Facility: Remote 

Department/Specialty: Pharmacy

Schedule: Full time 40 hours | Monday-Friday day shift 

Salary Range: $19.73-$26.70

• Empower through Clarity: You will demystify the complexities of healthcare billing, providing patients and their families with clear, transparent explanations of their financial responsibilities and the various payment pathways available to them.

• Identify Solutions: Beyond just explaining the "bill," you will proactively screen patients for insurance benefits and identify alternative funding sources, such as financial assistance programs or grants, ensuring cost is never a barrier to world-class care.

• Be a Fierce Advocate: You will act as the dedicated liaison between the patient and insurance carriers, navigating the "red tape" to ensure maximum coverage is secured and the patient’s best interests are always represented.

• Drive Sustainability: You will facilitate the pre-payment process with professionalism and tact, ensuring our organization remains strong so we can continue serving the community while helping patients resolve their balances before they become a burden.

Licensure / Certification / Registration:

Preferred Credential(s):

• Approved Local Exception. For use with unique Union job requirements only. Remove if not for Union.
• Certified Application Counselor credentialed from the state of Wisconsin.

Education:

• High School diploma equivalency OR 1 year of applicable cumulative job specific experience required.
  • Note: Required professional licensure/certification can be used in lieu of education or experience,
    if applicable.

Additional Responsibilities:

• Confirms insurance coverage. Determines necessity for pre-authorization and obtains authorization for scheduled services
• 
  Ensures all treatment regimens are medically necessary and meet payer specific policies as part of the authorization process.
• 
  Manages the timely authorization or re-authorization requirements per payer policy, preventing any delay in care
  Validates drug formulary requirements as part of the authorization process. Communicates necessary changes to the appropriate leaders and clinical teams.
• 
  Partners with Financial Advocates and provider offices to optimize patient insurance coverage and maximize reimbursement.
• 
  Identifies patients that may be eligible for Ascension FAP, copay assistance, foundation assistance & manufacturer drug programs.
• 
  Coordinates appeals when regimens are denied at the time of prior authorization. May include direct communication with physicians, pharmacists and patients.
• 
  Maintains a well rounded knowledge of CPT codes, JCodes and ICD-10 codes
• 
  Serves as a resource to staff and external contacts on issues related to authorization processes, payor guidelines, coverage determinations and requirements, and billing.

Epic experience preferred.  Familiarity with hospital OP, buy & bill, specialty pharmacy and site of care requirements a plus. Desire to continually learn and grow is a must.

Familiarity with Wisconsin payer policies including site of care requirements desired.

High dollar medication authorization experience required.

Ascension 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 employer

Ascension 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.

Fraud prevention notice

Prospective applicants should be vigilant against fraudulent job offers and interview requests. Scammers may use sophisticated tactics to impersonate Ascension employees. To ensure your safety, please remember: Ascension will never ask for payment or to provide banking or financial information as part of the job application or hiring process. Our legitimate email communications will always come from an @ascension.org email address; do not trust other domains, and an official offer will only be extended to candidates who have completed a job application through our authorized applicant tracking system.

E-Verify statement

Employer does not participate in E-Verify and therefore cannot employ STEM OPT candidates.

Paid time off (PTO)
Various health insurance options & wellness plans
Retirement benefits including employer match plans
Long-term & short-term disability
Employee assistance programs (EAP)
Parental leave & adoption assistance
Tuition reimbursement
Ways to give back to your community

Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance, location and salary range at the time of the offer.