Financial Advocate, Oncology (Full Time, Days)

NorthBay Health•Vacaville, CA

6d•$32 - $39•Onsite

About The Position

The Financial Advocate is responsible for assisting patients and/or families to access financial resources. This position will work closely with social services, Cancer Center staff, and the business office to guide patients and/or families through the financial aspect associated with treatments received at the Cancer Center, including infusion services. The Financial Advocate will be available to patients and families to answer questions regarding their insurance, give estimates of co-pays, and to aid in obtaining prior authorizations for services. The Financial Advocate is responsible for obtaining necessary treatment authorizations, as well as meeting any reporting/utilization review requirements to ensure maximum reimbursement.

Requirements

Assisting patients and/or families to access financial resources
Working closely with social services, Cancer Center staff, and the business office
Guiding patients and/or families through the financial aspect associated with treatments
Answering questions regarding insurance
Giving estimates of co-pays
Obtaining prior authorizations for services
Obtaining necessary treatment authorizations
Meeting reporting/utilization review requirements to ensure maximum reimbursement
Communicating patient financial liability regarding co-payments, share of cost, deductibles, and other financial responsibilities
Assisting with obtaining “ free drug replacement “ from pharmaceutical company
Initiating, completing, and documenting prior insurance authorizations for treatment plan
Being cognizant of third party payer restraints, coverage and treatment allocation
Verifying and documenting eligibility and benefits for all payers
Identifying and resolving all managed care and third party requirements prior to initiation of treatment
Utilizing telephone and Internet eligibility sources appropriately
Working in conjunction with Business Office and Social Services to explore patient assistance programs and to arrange payment plan
Working closely with patients and the NorthBay Business Office to resolve account balances and establishing a payment plan
Providing medical documentation to Business Office for billing requirements
Researching and answering inquiries related to referrals, authorizations and eligibility, charges, EOB and denied claims
Providing assistance to Clinic Support Specialist (CSS) as needed with reception and authorization duties
Informing Supervisor/ Manager of all authorizations that are denied
Informing and updating patient of authorization status
Demonstrating sensitivity and empathy in all interactions with patients and families
Obtaining signatures on all required registration forms, including medical release forms, ABN forms for Medicare patients, and all HIPAA compliance requirements
Demonstrating interview skills and clearly defining the problems and concerns to patient/family systems
Providing information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring
Working closely with other members of the health care team
Contributing to annual reviews of peer performance
Assisting in the development of indicators, thresholds, study methods, and data collection
Responding to problems and opportunities to improve and/or advance the Financial Advocate role

Responsibilities

Meets with patients to communicate patient financial liability regarding co-payments, share of cost, deductibles, and other financial responsibilities as appropriate
Assist with obtaining “ free drug replacement “ from pharmaceutical company as needed. Initiates, completes, and documents prior insurance authorizations for treatment plan (i.e. chemotherapy, injectable medications, radiation)
Is cognizant of third party payer restraints, coverage and treatment allocation
Verifies and documents eligibility and benefits for all payers including identifying and resolving all managed care and third party requirements prior to initiation of treatment
Utilizes telephone and Internet eligibility sources appropriately
Works in conjunction with Business Office and Social Services to explore patient assistance programs and to arrange payment plan if necessary
Works closely with patients and the NorthBay Business Office to resolve account balances and establishing a payment plan
Provides medical documentation to Business Office for billing requirements
In collaboration with Infusion charge nurse Specialist and /or billing department researches and answers inquiries related to referrals, authorizations and eligibility, charges, EOB and denied claims.
Provides assistance to Clinic Support Specialist (CSS) as needed with reception and authorization duties
Other duties and responsibilities as assigned
Informs Supervisor/ Manager of all authorizations that are denied
Informs and updates patient of authorization status as appropriate
Demonstrates sensitivity and empathy in all interactions with patients and families
Obtains signatures on all required registration forms, including medical release forms, ABN forms for Medicare patients, and all HIPAA compliance requirements
Demonstrates interview skills and clearly defines the problems and concerns to patient/family systems as needed for medically related financial needs
Provides information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring
Works closely with other members of the health care team to ensure a positive and effective work environment
Contributes to annual reviews of peer performance
Assists in the development of indicators, thresholds, study methods, and data collection as assigned
Responds to problems and opportunities to improve and/or advance the Financial Advocate role in assisting patients and families