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Position Summary

Serves as the primary patient advocate for financial navigation and counseling within an oncology practice. Reviews patient insurance coverage, establishes financial responsibility estimates, and coordinates prior authorizations and benefit verification to ensure seamless access to cancer treatment. Assists patients with understanding their insurance benefits, out-of-pocket costs, and available financial assistance programs. Partners with clinical teams, insurance companies, and external assistance organizations to remove financial barriers to care and optimize patient collections while providing compassionate support during the cancer treatment journey.

Key Performance Areas

KPA 1 – Insurance Verification, Authorization & Coverage Management

• Monitor and coordinate internally and externally with insurance companies on the pre-certification and prior authorization processes, including peer-to-peer and appeals, seeking support from provider or pharmacy team when applicable.
• Review assigned patient(s) and/or Physician schedules for upcoming visits and/or treatment to establish patient financial responsibility.
• Review patients' treatment plan(s) and identify if insurance benefit coverage is active and patient fiscal responsibility; all unplanned exceptions are to be communicated to provider immediately.
• Review and identify new treatment orders, generate an estimate of service and review with patient explaining insurance benefits and fiscal responsibility.
• Keep patients' insurance benefits up to date in EMR systems and view the patients' services for diagnosis and insurance coverage appropriateness.
• Communicate openly and routinely throughout the course of the workday with providers, nursing staff, PSS staff, UM team and coworkers through Teams, phone calls, emails and in person to discuss fiscal responsibility and other items as needed.

KPA 2 – Patient Financial Counseling & Assistance Coordination

• Discuss and explain forms and paperwork needed such as waivers, treatment estimates, payment plans, assistance applications, etc.
• Assist patient(s) with completing necessary paperwork for assistance and other grant funded programs in order to secure financial aid for treatment and services.
• Have an understanding of patient assistance programs and grant services processes to ensure adequate application, placement, and coordination with financial aid counseling team.
• If applicable, obtain necessary information from patient for assistance income guidelines.
• Identify and review patient aging balances and establish proper arrangements with the patient to address outstanding balance(s).
• Work closely with outside entities to ensure full collaboration and completion of forms and items needed in a timely and sometimes urgent manner.
• Responsible for monitoring and collecting the financial responsibilities of patients in a compassionate and professional manner.

KPA 3 – Compliance, Communication & Patient Advocacy

• Understand and comply with all Federal and State laws and regulations pertaining to patient care, rights, safety, billing, and collections.
• Maintain and ensure the confidentiality of all patient and employee information at all times in accordance with HIPAA regulations.
• Adhere to all Company and departmental policies and procedures.
• Serve as patient advocate to navigate financial complexities.
• Maintain professional, compassionate communication with patients and families during financially sensitive conversations.

Job Qualifications

Education

• High School Diploma or equivalent required.
• Associate's Degree or higher in Healthcare Administration, Business, or related field preferred.

Minimum Relevant Experience

• A minimum of two years experience in the healthcare field, preferably in healthcare financial counseling, patient access, or medical billing.
• Demonstrated knowledge verifying pre-certification and/or prior authorization with medical insurance.
• Experience with patient assistance programs and financial aid resources preferred.
• Prior Cash handling and monetary collection experience.
• Ability to calculate and collect patients’ responsibility and insurance co-pay/coinsurance.
• Proven Insurance knowledge requirements including an understanding of medical terminology, ICD9, ICD10 and CPT codes.
• Excellent proven verbal and communication skills needed to support diverse patient populations with empathy and cultural sensitivity.

Skills

• Familiarity with patient assistance programs, grant-funded resources, and pharmaceutical assistance programs.
• Proficiency in EMR systems, practice management software, and insurance verification tools.
• Advanced proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Strong interpersonal and communication skills with ability to explain financial information in understandable terms.
• Ability to work collaboratively with clinical teams, insurance companies, and external organizations.

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