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Financial Advocate, Oncology (Full Time, Days)

Northbay Healthcare -
Vacaville, CA

Job Details

Full-time
$31.69 an hour

Qualifications

Writing skills

Full Job Description

At NorthBay Health, 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.

PRIMARY JOB DUTIES

Business

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

Communication

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

Professional Development

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

Education: Bachelor’s degree in business or health related field preferred, or five years’ experience in a hospital business office or clinic setting.

Experience: Experience with at least two of the following strongly preferred: Multiple insurance types, referral and authorization processes, and knowledge of health insurance / benefit requirements. Demonstrated experience in area of clinical department preferred.

Skills: Assertive and persistent with strong organizational and written/spoken communication skills essential. Ability to work independently on a variety of complex tasks, managing competing deadlines. Demonstrated working knowledge of Windows, Microsoft Word, and Excel. Knowledge of medical terminology. Detail oriented with typing and computer entry ability and a working knowledge of general

Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort : Attendance is an essential function of the job. 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 may participate in the following activities : Requires sitting and standing frequently up to 6 hours per day. Requires frequent use of telephone, writing and computer keyboard six or more hours each day. Requires walking, stooping, bending, twisting and squatting occasionally up to 3 hours per day.

Hours of Work: Assigned shift during established Department office hours.

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