GENERAL SUMMARY AND PURPOSE: 

Responsible for implementing procedures to maximize reimbursement and minimize financial losses as related to authorization requirements for specialty care services, such as oncology, neurology and nephrology. Assesses financial needs of new and established patients according to specified protocol for Cancer Care Centers and other specialty clinics as assigned.  Provides services in areas of financial need to patients, families, and the health care team as appropriate.  Explores, recommends, and coordinates the varied financial assistance options available to patients in order to ensure the provision of the best financial resources possible for each patient in assigned specialty clinics, while maximizing revenue for the company. 

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:  

Bachelor's degree in Healthcare, Business, or Finance preferred.  5 years of experience working with customer service or financial needs of patients in the medical field may be considered in lieu of degree.  

Minimum of 2 years of experience working in a specialty clinic, hospital, or finance setting required, preferably in oncology. 

Minimum of 1 year of experience in determining insurance medical benefits preferred. 

Advanced training and/or certification, such as Registered Nurse, Licensed Practical Nurse, Certified Pharmacy Technician, or medical coding preferred.  

ESSENTIAL FUNCTIONS: 

Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.   

Responsible for obtaining pre-authorizations for all oncology related treatment. 

Responsible for obtaining applications for assistance programs (copay and free drug) available to oncology patients and specialty care patients seen in the hospital for outpatient or inpatient infusions. 

Maximizes the organization’s ability to reduce unnecessary financial losses associated with prior authorizations and utilization of patient assistance programs (to include free drug programs). 

Responsible for case management of complex financial clearance needs for patients, and elevates cases to Specialty Care Coordinator and/or Manager as appropriate. 

Processes requests from billing team or insurance company for letters of medical necessity. 

Assists in the development and tracking of indicators, thresholds and data collection as assigned. 

Monitor assigned patient accounts through entire revenue cycle to ensure copay program claims, payments, denials, and other assistance programs are being processed properly. 

Assists with ordering, tracking, and reporting of all free drugs obtained. 

With a high level of initiative, assesses the financial needs of Cancer Center patients, establishes a positive supportive relationship, works collaboratively with the Care Team in developing a plan of care, and thoroughly documents the findings, recommendations, and interventions made. 

Communicates and collaborates with the treatment team on the financial implications of medical intervention to both the patient and the health care provider. 

Coordinates with the patient, physician, insurance company, and pharmaceutical company to complete the required pre-authorization process for specified chemotherapy drugs, to include diagnostic and prior therapy requirements according to FDA and NCCN guidelines. 

Interacts with patients and families with varying developmental and socio-cultural backgrounds to reduce anxiety and conveys and attitude of acceptance, sensitivity, and caring. 

Participates in activities to enhance professional development, to include proactively attending educational sessions with pharmaceutical companies and other financial advocacy organizations. 

Takes initiative and action to respond, resolve, and follow up with customer service issues for all customers in a timely manner. 

Reports to appropriate personnel regarding assignments and projects. 

Maintains confidentiality in matters relating to patients and families. 

Willingly accepts personal responsibility for decisions, actions, attitudes, and behaviors that contribute to the overall effectiveness of the organization.  Communicates effectively, follows through on assignments, uses resources efficiently, participates in learning opportunities, and treats others with respect and dignity. 

Serves as a role model and performs job responsibilities to the highest standards in every situation.  Delivers highest level service that ensures a more complete and personally satisfying experience for every customer. 

Understands and demonstrates behaviors consistent with the mission and values of the organization while contributing to the overall success of the strategic plan.  All actions are rooted in providing excellent customer service. 

Demonstrated working knowledge of medical terminology, pharmaceuticals, Current Procedural Terminology (CPT) codes, and ICD-10 codes. 

Must be knowledgeable in all areas of revenue cycle, from account creation to denials management and collections. 

Ability to manage a variety of tasks and problems at the same time, including coordinating work so deadlines are met.  Multiple assignments often need to be prioritized daily.   

Ability to troubleshoot a variety of problems. 

Displays a high level of initiative and ability to self-direct to solve financial problems of patients. 

Ability to work collaboratively with the treatment team.  Must be able to work in an environment with a high level of activity, distractions, and numerous interruptions.   

Knowledgeable in programs available to assist patients with their financial needs. 

Proficient in MS Office applications.