Finance Specialist

Duties As a member of the Oncology/Infusion team, the Infusion Finance Specialist manages and/or coordinates all financial issues with patients, insurers, referring/attending physicians, care coordinators, pharmacy staff, and other stakeholders related to medications administered in the clinic/infusion center. Verify insurance coverage; assesses level of benefits; obtains payer approvals for high cost drug therapies prior to patient treatment; solves problems with insurers; provides financial counseling and support for patients as needed during their course of treatment. Accept and process all referrals, identify payer sources, verify benefit information and acquire initial authorization as needed to begin patient service or to determine denial of patient service. Follow up on pending unresolved coverage issues and claim denials. Document and communicate to appropriate providers and internal department''s accurate authorization information on current or potential patients. Provide superior customer service to all internal and external customers.Skills Using strong knowledge of insurance, revenue cycle and oncology infusion and accordance with department Standard Operating Procedures (SOPs) and any regulatory or compliance requirements: Perform verification of insurance benefits, analysis and identify any potential coverage issues Assure fast, easy access to infusion services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process Ability to independently synthesize NCCN/FDA coverage guidelines of complex/rare disease Provide financial counselling and support for patients as needed during the course of their treatment communicating options for financial assistance as appropriate. Advocate for patient on risk/dangers of Financial Toxicity Advise clinical teams on preferred alternative therapies Research to find other programs for payment and/or negotiate with providers, third party payers and drug manufacturers to provide coverage or exceptions. Assist in resolving problems with payers and provide information and expertise to other departments. Partner with potential international and self-pay patients on any financial or service needs related to their infusion care Coordinate with staff to identify appropriate patients for home and outpatient infusion therapy including payor source, clinical information, and the ability of Home Infusion to provide a safe environment for infusion therapy. Drug care coordination between infusion center, home infusion and specialty pharmacy Work closely with Revenue cycle on claim issues for resolution Serve as a resource to the affiliations, staff and physicians regarding infusion services. Assist with the coordination of services by communicating effectively and in a timely manner with others. Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training. Other administrative responsibilities as assigned. Required Experience & Qualifications 3-5 years of revenue cycle, Prior authorization, financial counseling or contracting experience using an enterprise software system in healthcare or insurance organization. Baccalaureate degree in business, communications, social work or health care. 3-5 years of revenue cycle, prior authorization, financial counseling or contracting experience using an enterprise software system in the oncology or infusion service line of a complex healthcare D-PF

Created: 2021-11-29