Imagine a career at one of the nation's most advanced health networks.
Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.
LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.
Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.
Summary
Reviews daily infusion center schedules to ensure standard of care and obtains proper authorizations to ensure account collectability for chemotherapy and supportive care treatments. Collaborates with patient financial services to resolve issues pertaining to authorization and medical necessity denials to protect hospital revenue. Works with the patient/families to resolve account balance issues and assesses the patient for external resources to reduce patient's out of pocket expenses; completes applications and obtains patient financial information.
Job Duties
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Completes the following infusion schedule tasks for the Cancer Institute Infusion Centers: * obtains referrals and authorization * prepares medical necessity check * identifies uninsured/under-insured patients * verifies benefits and eligibility * ensures registration and billing accuracy * answers billing and insurance questions * tracks/reports all activities on a monthly basis (x:drive report) * arranges peer-to-peer process for LVPG Hematology Oncology office * facilitates self-pay and good faith estimates to present to patients
- Facilitates off-label or non-covered services process (ABN waiver process) including estimate charges and out of pocket costs.
- Assists patients with pharmaceutical drug replacement (IV and oral medication) and copay relief programs.
- Works denial work queues for medical necessity and missing authorization in collaboration with Patient Financial Services and Appeals departments.
- Refers patients to outside resources (PATHS) and APPRISE (advice on Medicare supplements/replacement) pharmacy charity card approval/distribution and cancer funds.
- Completes the following tasks if working at the Cancer Institute: * facilitates the financial assistance program process
Minimum Qualifications-
High School Diploma/GED
- 2 years Experience working in oncology
- Ability to anticipate and understand customer financial needs; document and/or relay patients needs to appropriate personnel.
- Demonstrates expert knowledge in determining third-party insurance medical benefits and billing requirements.
- Must be able to maintain confidentiality and have an understanding of patient's rights.
- Must understand oncology-specific treatments and related insurance coverage issues, including rules governing medical necessity.
- Must possess the ability to combine compassion with strong professional skills.
Preferred Qualifications
Physical Demands
Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.
Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.
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