Patient Services Associate II

Job Details

Job Description

The Patient Services Associate II (Oncology Infusion) is responsible for securing timely and accurate insurance authorizations for outpatient infusion services. This role ensures that all necessary documentation is obtained and submitted to payers to facilitate patient access to care without delays. The specialist serves as a key liaison between the clinical team, patients, and insurance providers, ensuring all requirements are met prior to scheduled treatments.

Essential Functions

• Review and process infusion referrals by verifying patient insurance coverage and benefits and obtaining prior authorizations for infusion medications and services.
• Collaborate with internal teams including providers, case managers, pharmacy, and billing to ensure accurate clinical documentation and resolve any issues related to authorizations or claim denials.
• Track and manage authorization workflows by monitoring pending requests, appealing denials as needed, and ensuring timely follow-up to avoid treatment delays.
• Maintain accurate records of all authorization activities and communications in the electronic health record (EHR) or designated systems.
• Ensure compliance with payer requirements, HIPAA regulations, and internal protocols while consistently demonstrating professionalism and the hospital's core values in all interactions.

Competencies:

• Knowledge of Medical Insurance and Payer Requirements: Strong understanding of commercial and government payer policies, prior authorization processes, and coverage guidelines specific to infusion therapies.
• Familiarity with Medical Terminology and Coding: Working knowledge of HCPCS, CPT, ICD-10 codes, and infusion-related clinical terminology.
• EHR and Authorization System Proficiency: Experience working with electronic health records (EHR) and payer portals (e.g., PEAR, Availity) for submitting and tracking authorizations.
• Attention to Detail: High level of accuracy in reviewing documentation and submitting authorization requests to avoid delays in patient care.
• Organizational and Time Management Skills: Ability to manage multiple authorizations simultaneously, meet deadlines, and follow up on pending requests efficiently.
• Strong Communication Skills: Clear and professional verbal and written communication with providers, insurers, patients, and internal teams.
• Problem-Solving and Critical Thinking: Ability to troubleshoot issues, appeal denials, and proactively resolve barriers to authorization.
• Team Collaboration: Works effectively with cross-functional teams including providers, case managers, pharmacy, and billing.
• Patient-Centered Approach: Committed to minimizing treatment delays and enhancing access to care through timely and accurate authorizations.
• Compliance and Confidentiality: Knowledge of HIPAA and ability to handle sensitive patient and payer information responsibly.
• Knowledge of Medical Insurance and Payer Requirements: Strong understanding of commercial and government payer policies, prior authorization processes, and coverage guidelines specific to infusion therapies.
• Familiarity with Medical Terminology and Coding: Working knowledge of HCPCS, CPT, ICD-10 codes, and infusion-related clinical terminology.
• EHR and Authorization System Proficiency: Experience working with electronic health records (EHR) and payer portals (e.g., PEAR, Availity) for submitting and tracking authorizations.
• Attention to Detail: High level of accuracy in reviewing documentation and submitting authorization requests to avoid delays in patient care.
• Organizational and Time Management Skills: Ability to manage multiple authorizations simultaneously, meet deadlines, and follow up on pending requests efficiently.
• Strong Communication Skills: Clear and professional verbal and written communication with providers, insurers, patients, and internal teams.
• Problem-Solving and Critical Thinking: Ability to troubleshoot issues, appeal denials, and proactively resolve barriers to authorization.
• Team Collaboration: Works effectively with cross-functional teams including providers, case managers, pharmacy, and billing.
• Patient-Centered Approach: Committed to minimizing treatment delays and enhancing access to care through timely and accurate authorizations.
• Compliance and Confidentiality: Knowledge of HIPAA and ability to handle sensitive patient and payer information responsibly

• Minimum Education and Experience Requirements:

  Education:

  High school diploma or GED required.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

At Jefferson, we offer a comprehensive total rewards package designed to support the health and well-being of our colleagues and their families. It includes a wide range of benefits including competitive pay, health and retirement benefits, life and disability insurance, paid time off, educational benefits, financial and mental health resources and much more. Our diverse benefits offerings ensure you have the coverage and access to services you need to thrive both personally and professionally.