Counselor-Finance

Responsibilities

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services.
• Utilize multiple healthcare websites
• Review patient medical records and identify necessary information for pre-certification for confirmation of medical necessity
• Tracks, obtains, and extends authorizations from various carriers in a timely manner
• Meet with new patients to provide patient-specific education on their insurance benefits and estimated out-of-pocket expenses for their prescribed therapy prior to treatment initiation
• Works with patients and caregivers to collect deductibles and co-pays and set up payment plans
• Obtains necessary consent forms and financial documents from patients and providers to initiate applications for copay assistance and PAP drug programs
• Affords self-pay patients with initiating applications for the Baptist Financial Assistance Program
• Works closely with physicians and clinic staff to promote positive patient outcomes and timely treatment
• Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff
• Performs other duties as assigned

Qualifications

• Preferred: Associates degree or 2 years of college level courses.
• Minimum: 3 years of business-related office experience with 1 of those years being healthcare related experience.
• Preferred: 5 years of business experience in a healthcare environment. Front-end collections experience desired.
• Preferred: Knowledge of oncology pre-certification requirements and guidelines.
• Basic computer skills, ability to perform basic math computation, type 25 words per minute, and problem-solving skills.
• Dealing with confrontational issues and high stress situations with patients, family, and physicians.