Employee Type:

　　Regular

　　Work Shift:

　　Day - 8 hour shift (United States of America)

　　Join Team Tidelands and help people live better lives through better health!

　　Position Summary :

　　The Oncology Financial Navigator works with patients and their families to help them reduce stress or hardship related to the cost of treatment of their medical condition. Financial Navigators help patients understand their out-of-pocket expenses and what their health insurance plans may cover. Financial navigators also help patients find cost-saving methods for treatments and improve access to healthcare services that the patient needs.

　　Position Responsibilities & Functions

　　Review the Oncology Treatment Schedules for all three offices to verify insurance eligibility for each patient as well as determine if authorization is required for the patient’s treatment regimen. If an authorization is required, and is not on file, pass off to the Oncology Authorization Representative to obtain necessary authorizations.

　　Obtain authorizations for STAT Oncology treatments. Scan authorization into Meditech and Aria.

　　While reviewing treatment schedules, identify Financial Assistance opportunities depending on patient’s insurance status, such as Tidelands Financial Assistance, TCCN, Drug Assistance and Co-Pay Assistance.

　　Meet with patients to discuss Financial Assistance opportunities and obtain patient consent and signatures as needed.

　　Discuss Insurance maximization options with patients with regards to enrolling in a plan that would be more beneficial to them, examples, Affordable Care Act, Medicare, Medicare Supplement, Medicare Advantage Plan, Medicaid etc. Meet with patients during Open Enrollment periods to inform them of the plans that may be available to them. Refer patients to The Palmetto Project who may need assistance in enrolling with a licensed agent.

　　For Self-Pay patients who are approved for Free Drug Assistance, coordinate delivery of drugs to treatment center for each treatment date and log into the Financial Navigation Tracker to report savings to the Hospital.

　　Remove all charges for free drugs received from patient accounts prior to claims being submitted to insurance.

　　For patients who have insurance but have high deductibles and/or Out of Pocket maximums, enroll patient into a Co-Pay Assistance program/Grant if funding is available.

　　Load the Co-Pay Plan Program into Meditech on each account to ensure patient balance is dropped to the Co-Pay Plan Bucket prior to billing the patient.

　　File claims to the Co-Pay Assistance Program/Grant for payment by faxing or uploading UB04’s and EOBs to applicable program.

　　Closely monitor accounts for payments posted. Process payments that have been loaded on a virtual debit card in Experian. Log all payments into the Financial Navigation Tracker to report savings to the Hospital. Follow up on expected payments with the applicable program. Ensure payments have been posted correctly for reporting purposes.

　　Refer patients to programs for assistance with mortgage payments, utilities, gas cards etc.

　　Respond to emails from the Billing Department and/or Denials Team regarding Oncology claim issues. Review/investigate/respond.

　　Appeal claims denials with applicable medical records to support the specific chemotherapy regimen.

　　Attend departmental meetings with Infusion, Pharmacy, Physician and Scheduling staff.

　　Attend in-service meetings with drug reps to ensure we are kept informed of new drugs/biosimilars with regards to coding/billing and the financial assistance available.

　　Work closely with Oncologists and Pharmacists to ensure patients are receiving the appropriate preferred drugs and/or Biosimilars in accordance with patient’s insurance.

　　Works closely with the scheduling department to determine if a prior authorization will be needed before a patient can be scheduled for treatment.

　　Assist patients with their Cancer Insurance Policies by providing them with monthly itemized statements for their claim submission.

　　Interview potential new hires when the need arises for additional staff.

　　Create and update training materials as needed for new hires.

　　Performs related duties as assigned.

　　QUALIFICATIONS

　　Education :

　　Must meet one of the following:

　　Bachelor degree (preferably in: business, finance, biology, or chemistry) with 2 years experience, as specified.

　　Associate degree (preferably in: business, finance, or sciences) with 4 years experience, as specified.

　　High school diploma with 6 years experience, as specified.

　　Experience :

　　Specific experience and/or knowledge with the following:

　　Patient financial counseling, patient customer service, scheduling, or prior authorization.

　　Detailed knowledge of third party payor regulations related to managed care, denials, and reimbursement issues.

　　Terminology for hospital billing.

　　CPT and ICD-10 coding.

　　Hands-on knowledge of the Experian Health, Inc. Charity Guide and PayNav tools.

　　Utilization of the MS Office suite.

　　Experience with chemotherapy drugs, oral drugs and specialty pharmacy utililization, preferred.

　　License/Certification :

　　Accredited Financial Counselor (AFC), preferred.

　　Certified Revenue Cycle Representative (CRCR), preferred.

　　Skills :

　　Ability to negotiate point of service payment.

　　Ability to review and explain insurance processing per explanation of benefits when necessary.

　　Ability to rebill insurance claims when necessary.

　　Demonstrated ability to exhibit exemplary core customer skills at all times.

　　Independent decision-making skills, collaborative abilities, and organizational and time management skills.

　　Other :

　　Incumbent must have the ability to work evenings, as needed.Physical Requirements : Light Physical Agility Test (PAT) Rating

　　While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

　　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.

　　Tidelands Health is an equal opportunity employer (EOE). Tidelands Health does not discriminate against employees or applicants for employment on the basis of race, color, creed, religion, age, national origin, disability, marital status, veteran status, gender, genetic information, familial status, or any other legally protected status.