Oncology and Infusion Reimbursement Specialist

Saint Luke's Health System•Kansas City, MO

8d•Hybrid

About The Position

Under minimal supervision, position is responsible for assessment and coordination of financial requirements for recommended, time-sensitive cancer treatments. Serves as an advocate for oncology patients, helping them navigate through insurance and eligibility verification, financial distress screening, pre-certifications and prior authorizations, insurance education and optimization, and access to financial assistance—all complicated by everchanging payor drug coverage policies and approval pathways. Treatments include chemotherapy, surgery, radiation therapy, office visits, hospital stays, counseling, nutrition, and other cancer-related therapies. Position is in constant communication with patients, physicians, inpatient care coordinators, nursing staff, authorization staff, oncology leadership and third-party payers, and helps ensure financial sustainability for patients and the cancer program by improving patient care and appropriately capturing revenue. Shift: Monday- Friday 40 hours a week. This position has the capacity to hybrid in the Kansas City area.

Requirements

Minimum five years medical business office experience with referrals, third party benefit verifications, treatment authorizations and patient interaction, required.
Working knowledge of healthcare insurance, particularly Medicare and Medicaid.
Knowledge of diagnostic (ICD-10), procedural (CPT, HCPCS) coding and cancer terminology, required.
Basic Microsoft Office computer skills, including Excel, Word, and Outlook.
Familiarity with basic functions of an EMR.

Nice To Haves

Associate’s degree in health sciences and/or medical records certification, preferred.
Knowledge of NCCN guidelines for drug therapy indications and patient advocacy and drug replacement programs, a plus.

Responsibilities

Performs financial counseling process on all patients for treatment, which includes outlining and explaining financial obligations and billing processes and establishing needed payment arrangements for planned treatments and/or procedures.
Performs or coordinates insurance verification with third-party payers.
Coordinates with Oncology and Infusion Reimbursement Specialist regarding treatment authorizations.
Maintains a focus on accuracy, timeliness, and adherence to processes to facilitate patient access to treatments.
Ensures all demographic, insurance, and patient eligibility information is obtained, current, and entered in the EMR.
Answers billing and insurance questions as needed.
Ensures that all services requiring authorizations and/or referrals have valid ones on file.
Communicates effectively with payers and various stakeholders (clinical teams, care coordinators, pharmacy, reimbursement specialists and billing) regarding the status of authorizations, Cobra, continuation of care coverage, network status and/or other updates, as needed.
In conjunction with oncology social workers and inpatient care progression, analyzes all uninsured and out of network patients.
Documents case activity, communications, and correspondence in Epic to ensure completeness and accuracy of account activity, and that actions are taken to resolve outstanding authorization issues.
Serves as a point of contact with patients and strives to keep them continuously informed of coverage and authorization issues.
Re-verifies benefits and ensures authorization and/or referral after treatment plan has been discussed prior to the initiation of treatment.
Ensures appropriate signatures are obtained on all relevant forms.
Assists insured, uninsured and underinsured patients in obtaining financial assistance (e.g. Medicaid, drug replacement, help with copays), outside assistance, and helps patients complete necessary forms relative to financial liability and estimated treatment costs.
References NCCN guidelines for drug therapy indications payable by third parties and seeks out patient advocacy and drug replacement programs that enhance or replace charity care provided by the hospital.
Helps patient complete necessary forms related to supplemental insurance coverages.
Builds and maintains relationships with various cancer program stakeholders including physicians and APPs, nurses and medical assistants, navigators, pharmacists, registration and scheduling staff, hospital revenue cycle team, reimbursement specialists, social workers, and internal charity program managers.
Communicates to the treatment team any anticipated issues with coverage that may impact the sequencing and timeliness of care.
Tracks, reports, and escalates to leadership service issues arising from insurance coverage or other issues that delay service, to ensure patient access and to avoid delays that may interrupt therapy and treatment plans.
May assist with the resolution of problem claim reimbursement issues on occasion.
Demonstrates an understanding of the need for patient confidentiality to protect the patient and the hospital.
Follows all necessary HIPAA regulations to protect patient information.
Responsible for working with billing office staff to set up payment plans within hospital guidelines for patients who cannot pay balance in full.
Other duties, as assigned.