"Alerted.org

Job Summary:

This individual is responsible for performing the Financial Navigation for all patients to include pre-registration at least 3 days in advance of appointment, financial clearance functions including but not limited to verifying insurance eligibility and benefits. They will ensure patients are financially cleared, screened for patient discounts including financial assistance and enrolled in co-pay or free drug programs. The position works closely with the Oncology Team and the Financial Navigator Team while following the State and Federal Regulations.

Qualifications:

+ Education

• High school diploma or equivalency (GED)

• Associate's degree in healthcare administration or equivalent college coursework preferred.

Experience

• 3-4 years of work experience within hospital/physician office or related areas

• Prior experience with Patient Accounts or Registration

Knowledge, Skills, Abilities

• Strong organizational skills and ability to prioritize tasks.

• Strong interpersonal skills and ability to work with a wide variety of individuals.

• Knowledge of payer reimbursement process and insurance terminology.

• Basic understanding of procedure codes (CPT, HCPCS, ICD 10 coding, etc.)

• Ability to identify and solve problems independently by using critical thinking.

• Excellent computer skills and the ability to adapt to various programs/systems.

• Excellent in verbal and communication skills

Job Duties and Standards:

+ Reviews daily schedule at least 3 days in advance to ensure all scheduled patients have been pre-registered and coverage has been verified or updated as needed. Those patients with minimum coverage or without adequate coverage should be screened for financial assistance and informed of any document needed to complete the process. Check to determine if an active hardship application is on file.

+ Meets with patients that may need charity care or assistance with insurance coverage questions. Obtains all necessary financial documents needed and works along with the Financial Navigation Team to complete the process.

+ Screens all new treatment patients and patients with a change in their treatment plans to assess their eligibility to be enrolled in a co-pay assistance drug program.

+ Attends weekly treatment team meetings to identify and bring patient insurance coverage, co-pay assistance, and free drug issues to the forefront.

+ Conducts personal interviews and telephone inquiries to assist patients with insurance coverage, cancer policies and co-pay assistance.

+ Enrolls/assist patients with obtaining free drug or drug reimbursement for IV and Oral treatments. Coordinates with nursing staff and pharmacy team.

+ Completes prior authorizations for non-oral chemo drugs that are filled by outside retail pharmacies.

+ Maintains financial reports as required.

+ Determines financial risk based on financial assistance guidelines.

+ Explains the financial clearance policy to patients and answers any additional questions.

+ Evaluates and follows up with patients eligible for charity care to see if other financial coverage is available.

+ Compiles necessary paperwork for patients eligible under grant funding.

+ Process co-pay assistance for patients.