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Northern Light Eastern Maine Medical Center

Department: Radiation Oncology

Position is located: Lafayette Building

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: Variable

Summary:

The Financial Review Specialist is responsible for coordinating the day-to-day operations of insurance verification, PCP referrals, medical necessity screening and prior authorizations for specialized outpatient infused drugs, procedures and imaging. Responsible for understanding the complexities of commercial and government-funded health plan requirements. These include variations in coverage guidelines and payer documentation required to request and appeal submissions.

Responsibilities:

+ Assists pharmacists and patient advocates with urgent and/or complex pre-certification needs.

+ Acts as a liaison between staff, Financial Counselor, Scheduling and Check-In to ensure coverage of all services.

+ Responsible for educating staff on new and existing insurance verification software. This includes securing access, instructing on documentation standards and QA post-implementation.

+ Conducts periodic quality audits of routine transactions in a quantitative format.

+ Orients new insurance verification employees using a skills assessment tool and advises manager of progress.

+ Assists Manager and the Revenue Cycle Team with process improvement.

+ Covers insurance verification, PCP referral, medical necessity screening and prior authorization functions as needed.

Other Information:

Competencies and Skills

+ Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

+ Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.

+ Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

+ Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

+ Required Associate's Degree

Working Conditions

+ Potential exposure to noise levels being uncomfortable.

+ Work with computers, typing, reading or writing.

+ Prolonged periods of sitting.

+ Prolonged periods of standing.

+ Prolonged periods of walking.

EMMC, Bangor, Maine, Level 2 Trauma Center, hospital, Cancer Care, Lifeflight

Position Financial Review SpecialistLocation Req ID 82845