Financial Advocate, Oncology (Full Time, Days)

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

1. Meets with patients to communicate patient financial liability regarding co-payments, share of cost, deductibles, and other financial responsibilities as appropriate

2. 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)

3. Is cognizant of third party payer restraints, coverage and treatment allocation

4. 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

5. Utilizes telephone and Internet eligibility sources appropriately

6. Works in conjunction with Business Office and Social Services to explore patient assistance programs and to arrange payment plan if necessary

7. Works closely with patients and the NorthBay Business Office to resolve account balances and establishing a payment plan

8. Provides medical documentation to Business Office for billing requirements

9. 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.

10. Provides assistance to Clinic Support Specialist (CSS) as needed with reception and authorization duties

11. Other duties and responsibilities as assigned

Communication

1. Informs Supervisor/ Manager of all authorizations that are denied

2. Informs and updates patient of authorization status as appropriate

3. Demonstrates sensitivity and empathy in all interactions with patients and families

4. Obtains signatures on all required registration forms, including medical release forms, 

5. ABN forms for Medicare patients, and all HIPAA compliance requirements

6. Demonstrates interview skills and clearly defines the problems and concerns to

patient/family systems as needed for medically related financial needs

1. Provides information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring

2. Works closely with other members of the health care team to ensure a positive and

   effective work environment

Professional Development

1. Contributes to annual reviews of peer performance

2. Assists in the development of indicators, thresholds, study methods, and data collection as assigned

3. Responds to problems and opportunities to improve and/or advance the Financial Advocate role in assisting patients and families

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

2. 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. 

3. Skills:  Assertive and per