City/State:

Bronx, New York

Grant Funded:

No

Department:

Onc - Revenue Cycle

Bargaining Unit:

1199

Work Shift:

Day

Work Days:

MON-FRI

Scheduled Hours:

9 AM-5:30 PM

Scheduled Daily Hours:

7.5 HOURS

Hourly Rate:

$35.30

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

To learn more about the “Montefiore Difference” – who we are at Montefiore and all that we have to offer our associates, please click here.  

Job Summary:

Provide lead oversight of Cancer Care Center (Eastchester 1695 Practice/OP Infusion, Moses Practice/ OP Infusion, Blondell Practice / Infusion) cases involving supporting revenue cycle operations for Medical Oncology, including ensuring all billing requirements are met prior to patients being seen. Requires an experienced revenue cycle professional with extensive knowledge of Medical Oncology operations, Epic EMR workflows, oncology treatment and therapy plan referrals, appointment templates, pre- and post-bill encounter workqueues, and complex oncology treatment plans. Must have a strong understanding of chemotherapy, immunotherapy, infusion services, specialty medications, and insurance requirements to support accurate billing and reimbursement. Plays as acting liaison between the Medical Oncology department, Pre-Service Unit, and Pharmacy.

Essential Functions:

• Serve as the primary liaison between the Cancer Care Center and the Pre-Service Unit (PSU). Coordinate routine and urgent referral requests, including same-day injections, medications, and treatment add-ons. Review the Epic Referral Communications tab, follow up on pending requests, and ensure completed referrals and authorizations are attached to the appropriate visit.
• Acting liaison between Medical Oncology and PSU authorization team to ensure correct treatment/therapy plan is scheduled correctly based on FDA approved guidelines and authorized units/counts are obtained prior to patient being seen.
• Has thorough understanding of reading oncology treatment plans as well as non-oncology therapy plans ordered by providers (drug dosage, units, counts). Is familiar with insurance plans and preferred biosimilars in efforts to avoid denials.
• Review Epic DAR to ensure correct insurance order and appropriate referral is attached to scheduled appointment in efforts to avoid denial.
• Communicates with all department parties (clinical and admin staff) in efforts to confirm all required items are obtained and preferred treatments are entered.
• Manage workqueues for oncology practices and resolve insurance, registration, oncology related authorization status/ treatment plan detail, and account issues that may affect treatment or billing.
• Refer uninsured oncology patients for Medicaid screening, financial assistance, and participating insurance options.
• Highly knowledgeable and experienced in understanding treatment/therapy plans, if they are scheduled correctly based on FDA approved guidelines and if correct authorized units/counts are obtained prior to patient being seen.
• Cover Financial Assistant positions when needed for all oncology infusion locations. Responsibilities include:          
  • Collect and reconcile daily patient collections in Epic and resolve payment discrepancies.
  • Verify insurance eligibility and benefits for oncology services, including chemotherapy, immunotherapy, infusions, injections, and specialty medications.
  • Assist patients with financial questions related to oncology treatment, including insurance coverage, treatment costs, and patient responsibility.

Qualifications:

• Associates Degree Required
• 5 years experience in outpatient hospital/medical oncology infusion centers. (Required)
• Knowledge of patient registration, insurance verification, treatment referrals, prior authorizations, patient financial responsibility, and payment collection processes. (Required)
• Knowledge of Medicare, Medicaid, commercial insurance plans, financial assistance programs, and patient assistance resources. (Required)
• Proficiency in Epic registration and workqueues, Real-Time Eligibility, treatment referral management, payment posting, and reconciliation. (Required)
• Ability to use payer portals, Outlook, Excel, and other systems to verify coverage, track issues, and prepare reports. (Preferred)
• Knowledge of patient privacy, customer service, medical terminology, and basic CPT, HCPCS, and ICD-10-CM terminology. (Preferred)
• Ability to prioritize urgent requests, communicate financial information, maintain accurate documentation, and collaborate with clinical and operational teams. (Required)

Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.