Patient Financial Advocate

Southwest Womens Oncology/Optimum•Albuquerque, NM

9d•Onsite

About The Position

The Patient Financial Advocate plays a crucial role in helping patients navigate the complex financial aspects of cancer treatment. This position is responsible for translating insurance, billing, and financial assistance information into clear and understandable terms for patients, thereby preventing financial hardship and ensuring revenue integrity and compliance for the practice. It is considered a critical function, not merely administrative support, and is held to the same high standards as clinical care. The role involves working at the intersection of revenue cycle management, compliance, and patient advocacy, serving as the primary financial navigator for patients across both Southwest Women's Oncology and Optimum Human practices.

Requirements

2+ years of experience in medical billing, revenue cycle management, or healthcare financial counseling.
Strong understanding of insurance benefits, EOB interpretation, and patient responsibility calculations.
Working knowledge of the No Surprises Act and Good Faith Estimate requirements.
Familiarity with Medicare, Medicaid, and commercial insurance plans.
Excellent interpersonal and communication skills with the ability to discuss sensitive financial matters with empathy and confidence.
Highly organized with strong analytical and problem-solving skills.
Proficiency with EMR, billing, and practice management systems.

Nice To Haves

Experience in oncology or infusion billing.
Experience securing manufacturer copay assistance, drug replacement programs, and foundation funding.
Familiarity with chemotherapy and specialty drug reimbursement workflows.

Responsibilities

Review patient accounts and insurance coverage prior to treatment to identify financial risk and outstanding balances.
Generate and deliver Good Faith Estimates (GFEs) in compliance with the No Surprises Act and applicable federal regulations prior to initiation of services.
Provide accurate cost estimates for chemotherapy, infusion therapy, surgical procedures, and specialty services.
Educate patients on insurance benefits, deductibles, coinsurance, and out-of-pocket responsibility with clarity and compassion.
Facilitate point-of-service collections and establish structured payment arrangements when appropriate.
Monitor outstanding balances and follow up proactively to resolve accounts in a timely manner.
Collaborate with billing staff to ensure financial workflows and documentation are accurate and complete.
Proactively identify and secure financial assistance on behalf of patients, including manufacturer copay assistance programs, drug replacement programs, foundation grants, and charitable funding resources.
Assist patients in completing required applications and gathering supporting documentation.
Monitor and manage awarded assistance funds, ensuring proper allocation to patient accounts.
Serve as a patient-centered resource for financial navigation throughout the entire course of treatment.
Partner with clinical, billing, and front office teams to ensure seamless financial workflows.
Communicate proactively with the care team regarding financial barriers that may impact treatment adherence.
Maintain strict adherence to HIPAA and all applicable federal and state compliance requirements.
Document all financial counseling interactions, assistance applications, and account activity accurately and completely in the EMR and billing systems.
Identify and recommend process improvements to enhance financial clearance workflows and patient outcomes.
Stay current on changes to insurance regulations, the No Surprises Act, and financial assistance program availability.