Job Description

General Summary

Provides support and financial navigation services for patients and family members. Responsible for the verification of patient benefits and oversee workflow to ensure accurate information is available prior to billing of claims. Assists patients with navigation through the cancer care system from appointment coordination through the complexities of financial obligations. Under limited supervision, determines liability on patient accounts, and works with patients or their representatives to provide financial assistance or secure payment. Facilitates processing of Medicaid and other financial assistance application and initiates eligibility determination. Follows up on delinquent accounts until resolved.

Essential Duties & Responsibilities

• Consistently arrives at work on time and adheres to regular work schedule.
• Provides support to cancer patients, families, and caregivers. May involve educating a person about the need for timely screening, helping someone access health insurance or low-cost screenings, finding transportation to treatment, and helping patients access information about treatment options.
• Coordinate financial support for all services performed within the oncology service line. Works in connections with the revenue cycle team and oncology pharmacy to ensure a seamless experience for the patient while making sure that the billing requirements and financial obligations are met.
• Facilitates enrollment process with commercial insurance coverage in pharmaceutical copay card programs as available for prescribed treatment regimen. Keep informed of regulatory changes and advance treatment solutions in order to provide the most up-to-date options for patient satisfaction.
• Estimates patient liability on accounts, evaluates credit histories and other resources.
• Counsels’ patient on cost of treatment, insurance benefits, resources for payment, and financial assistance. Secures and documents payment arrangements.
• Verifies and updates patient demographic information on registration and billing systems.
• Audits bills for accuracy.
• Collects deposits and payments.
• Assists potentially eligible patients in completing forms for bank loans, Medicaid, charity care and other sources of financial assistance within required timeframes.
• Reviews delinquent accounts to ascertain previous collection action taken, status and extent of insurance coverage and potential collectibles.
• Contacts those who have not responded to payment requests. Monitors monthly payers.
• Bills and re-bills third parties to charges posted after the billing and transfer date.
• Recommends, after extensive investigation, referral of accounts to attorneys or collection agencies for continued collection efforts.
• Answers inquiries and resolves complaints concerning account collection.
• Recommends bad debt accounts for write off.
• Processes adjustments to Accounts Receivable, include refunds.
• Prepares reports and maintains account activity logs.
• Acts as liaison with other service areas, family members, and physicians regarding billing requirements, and financial assistance, and coordinates activities to avoid reimbursement delays.
• Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
• Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors. Discusses patient and hospital information only among appropriate personnel.
• Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
• Actively demonstrates the organization's mission and core values, and conducts oneself at all times in a manner consistent with these values.
• Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.

Other Essential Duties May Include but Are Not Limited To

• Other duties as assigned.

Knowledge, Skills & Abilities Required

Required:

• Consistently arrives at work in appropriate/professional attire.
• Completes all tasks within established time frame.
• Adheres to all clinic policies and procedures.
• Knowledge of basic accounting principles and patient billing procedures. One to two years progressively more responsible related work experience.
• Interpersonal skills necessary to communicate effectively with patients and families when determining financial status, establishing payment arrangements, and collecting accounts, as well as with insurance companies and other Patient Financial Services department staff.
• Analytical skills necessary to calculate patient liability, income status and solve problems related to credit and collection matters.
• Demonstrated knowledge of patient accounting systems and accounts receivable.
• Must possess the following skills: Strong financial skills and a thorough understanding of financial issues and delivery system trends; Strategic understanding necessary to deal with the healthcare delivery systems of the future; Excellent communication, problem solving and negotiation skills; Interpersonal skills that promote energy, healthy debate, out-of-the-box thinking, and challenge new or existing vision; and a leadership style that engenders measured risk taking and autonomy.
• Must be: Results oriented; Decisive; Have the capability to be a strong mentor and collaborator.
• Strong team-oriented, results driven and collaborative style. Proven success in identifying partners and negotiating and executing complex deals.
• Broad based business acumen and understanding of various disciplines within the service line (operations, finance, technology, etc.).
• Minimum 5 years of experience in medical practice required, preferably in Oncology/Hematology/Chemotherapy/Infusion.

Education:

• High School Diploma.

Preferred:

• Associate degree in business or related field.
• Experience performing administrative functions.
• Insurance prior authorization experience.