Financial Coordinator, Oncology, 40 Hours.

UMass Memorial Health•San Jose, CA

5d•$22 - $37•Onsite

About The Position

Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. Responsible for the coordination of all financial aspects of assigned area. Works with patients and their families beginning with the evaluation for medical care, and continuing through and after the medical procedures in order to help facilitate access to and provide continuity of care. Work closely with other members of the clinical and administrative teams, contracting, Patient Financial Services and insurers to advise of financial issues related to ability to obtain payment.

Requirements

Associate Degree.
Minimum of 2 years financial experience in a hospital/medical related program.
Minimum of 2 years experience in medical insurance.
Demonstrates an understanding of insurance industry standards, payor payment methodologies, and managed care concepts.
Knowledge of insurance pre-certification and verification.
Knowledge of third-party regulatory guidelines.
Familiarity with medical terminology.
Excellent analytical and communication skills.
Knowledge of Medicare/Medicaid.

Responsibilities

Obtains detailed patient insurance benefit information for all aspects of the medical treatment process including, but not limited to, coverage and network requirements, outpatient prescription drugs, follow-up clinic visits, and travel and housing if necessary.
Reviews summary plan descriptions. Verifies specific co-pays, deductibles, out of pockets, contract maximum amounts, and outpatient pharmacy coverage for each patient.
As necessary, coordinates with the contracting department (who obtains the highest reimbursement for services on a case-by-case basis).
Manage proper course of action for maximum reimbursement of health care charges: spend-down eligibility, cobra coverage, etc.
Establish contact with case manager at insurer, employers and self-insured groups as needed.
Obtain insurance pre-certification for patients as necessary.
Monitors and updates patient insurance data, physicians, authorizations, preferred providers and documents in EMR with required financial guarantor notes.
Coordinates with physicians and other clinical staff to ensure accurate knowledge of treatment protocols and issues.
Coordinate and facilitate financial process for treatment services in collaboration with Contracting, Patient Accounts, Physician Billing and Reimbursement, and other departments as necessary.
Ensures compliance with Medicare/Medicaid regulations for treatment services.
Determine eligibility for government assistance programs. Calculate and assess discount percentages. Establish payment arrangements and settlements appropriately.
Act as a liaison between patients and insurance companies to assist in the resolution of reimbursement issues. Facilitates resolution of patient billing issues.
Serves as a resource for patients and their family members on financial matters.
Attends and participates in daily/weekly meetings as necessary. Communicates with members of the clinical team, patients, and their families in identifying any potential out-of-pocket expenses.
Attends seminars and courses on relevant topics, (i.e. Medicare/Medicaid, HMO’s, UNOS, etc.), educating affected areas and applying updated information accordingly for complete compliance of federal regulations.
Complies with established departmental policies, procedures and objectives.
Attends variety of meetings, conferences, seminars as required or directed.
Demonstrates use of Quality Improvement in daily operations.
Complies with all health and safety regulations and requirements.
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
Maintains, regular, reliable, and predictable attendance.
Performs other similar and related duties as required or directed.