What are the responsibilities and job description for the Financial Counselor - Oncology position at Starr Regional Medical Center?
The Oncology Financial Counselor supports patients during this challenging time, helping to reduce the financial burden throughout the continuum of their care. The Oncology Financial Counselor helps evaluate insurance benefits and discuss with patients their responsibility and programs available to assist with high co-pays or out of pocket amounts. The Oncology Financial Counselor obtains all authorizations for treatment and ensures criteria has been met and is accurate. They will help patients understand insurance benefits and obligations and assist patient with completing important paperwork for assistance programs if applicable. The Oncology Financial Counselor also coordinates with the business office in assisting with resolving claim issues and denials.
Core competencies include, but are not limited to the following:
Plan, schedule and maintain processes and performance to accomplish duties within time frames.
- Processes all Chemotherapy and Infusion Treatment Authorizations.
- Works fax que daily for new orders that require authorizations.
- Ensures all orders are valid with name, DOB, physician signature, ICD-10 code.
- Ensure all orders meet medical necessity
Appeal letters as needed for denials
- Works closely with Patient Financial Services to review any claim denials that have been authorized.
- Provides the necessary patient information required to support claim process & denials.
Manage all specialty pharmacy scripts that require authorization
- Work with specialty pharmacy for setting up new scripts.
- Fax scripts to specialty pharmacy for refills.
- Works with patients on copay and out of pocket cost for specialty drugs.
- Initiating mail order pharmacy enrollment
Patient Assistance Programs.
- Copay assistance.
- Drug replacement programs.
- Research available patient assistance programs.
- Obtain patient financial information to support assistance programs.
- Follow each patient on assistance programs and resubmit applications annually
Contribute to and promote positive relationships between physicians, hospital staff, guests and the local community.
- Respects at all times the confidentiality of patient information. Ensure compliance to confidentiality standards.
- Promotes a positive relationship between staff, physicians, patients and guests.
- Meets with other hospital personnel, physicians or patients to facilitate cooperation and resolve existing or potential conflicts. Handles conflict with tact and courtesy.
- Communicates effectively with patients in regard to financial information for treatment.
- Follows up on issues or complaints. Resolve problems that may occur in the financial counseling area in a timely manner.
- Participates in various hospital and community events.
Participates in the planning, development and implementation of annual department goals and objectives
- Reviews department’s goals annually, providing input and assists in the development of personal and team goals and objectives to support the plan.
- Adheres to Corporate Compliance Program.
- Responsible for maintaining and protecting the confidentiality of all Protected Health Information.
- All other duties as assigned.
Minimum Education
Associate's Degree in Medical Billing, Coding, Insurance, Healthcare Administration, or other related health science:
X Preferred Required
Minimum Work Experience
1-2 Years experience in billing or insurance
X Preferred Required
1-2 Years experience in hospital scheduling
X Preferred Required
1-2 Years experience in authorization and patient assistance
X Preferred Required
2-3 Years experience in Oncology & Hematology authorization and patient assistance
X Preferred Required
Required Skills
Requires critical thinking skills, decisive judgment and the ability to work under the supervision of Registered Nurse. Must be able to work in a stressful environment and take appropriate action.
Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran
