Description
Summary of Position:
The Financial Navigator - Oncology works closely helping cancer patients navigating the complex financial aspects of their care by assisting them with insurance, understanding costs, and accessing financial assistance programs. This job is responsible for performing financial clearance functions, including but not limited to, verifying insurance eligibility and benefits; obtaining and ensuring authorizations on file are accurate; and providing price estimates and Good Faith Estimates and cost estimates to scheduled patients. This position works closely with Revenue Cycle to ensure all patients are financially cleared and screened for financial risk. This includes securing pre-authorizations when necessary to facilitate timely appointments and support continuity of care within the health system.
Qualifications
Education:
• Associates or Bachelor's degree in finance, business, healthcare administration or other related field required
Experience:
• 2-3 years of work experience with insurance verification, revenue cycle functions, hospital/physician offices, or related areas required
• Oncology experience preferred
• Prior experience in Financial Counseling preferred
Knowledge/Skills/Abilities:
• Excellent verbal and written communication skills
• Comprehensive knowledge of insurance coverage, limitations, requirements, eligibility, pharmacy formulary, prior authorization, coordination of benefits, diagnosis codes, billing and collecting.
• Strong organizational skills and ability to prioritize tasks
• Strong interpersonal skills and ability to build rapport with a wide variety of individuals
• Knowledge of pharmaceutical payer policy and reimbursement processes
• Working knowledge of medical terminology
• Ability to identify and solve problems independently
• Excellent computer skills and the ability to adapt to various programs/systems
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is frequently required to walk, stand, sit, and talk or hear.
• The employee is occasionally required to use hands to finger, handle, feel or operate objects, tools, or controls; and reach with hands and arms.
• The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl.
• Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.
• The employee must occasionally lift and/or move up to 25 pounds.
Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Normal office environment. The noise level in the work environment is usually quiet to moderate while in the office.
• Occasional travel to various health system locations.
Essential Functions
1. Provides consistently exceptional care at all times.
2. Meets with patients on a one-on-one basis to discuss cost of hospital services and patient's current financial situation, obtaining all pertinent demographic and financial data to ensure resolution of account.
3. Educates, screens, and assists patients without valid insurance coverage with enrollment in programs including, but not limited to, Medicare, Medicaid, other state-based assistance programs, etc.
4. Promotes an integrated/coordinated approach to managing the continuum of care and financial obligations for the patient and their family members.
5. Serves as a liaison to patients with internal and external resources for co-pay assistance, drug
replacement, and other financial assistance.
6. Assists with developing and implementing standard operating procedures to guide and build a program that effectively supports the care and financial responsibility of patients.
7. Coordinates with clinical team and social workers in identifying eligible patients for cancer care program.
8. Monitors and tracks the status of applications and communicates with the pharmacy, physicians, and clinical team.
9. Clarifies patient medications and dosages and generates applications for Payment Assistance Programs (PAP) renewals.
10. Educates caregivers and administration on the processes and procedures surrounding PAP's to increase patient referrals.
11. Captures data queries that will drive decisions and process improvement for treatment delivery and collaboration with payers.
12. Obtains authorizations and documents the authorization number and period of validity dates for approved procedures and treatments, submits letters of medical necessity and follow-ups on approvals for procedures.
13. Gathers additional medical records from outside providers as needed to support medical necessity when obtaining a pre-authorization, and follows up with payers on pre-authorization requests as needed.
14. Ensures specialists have all clinical information necessary for referral appointments, and sends any additional documents upon request.
15. Alerts the clinicians involved in the patient's care when there are issues with referrals or complications with insurance coverage.
16. Informs the patient whether the authorization for the referral has been approved, denied or delayed, and reviews the next steps of care with them, including providing appointment reminders.
17. Responds to the needs of the department by performing other duties, as necessary.
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