Patient Access Analyst, Oncology

About the role

At Hackensack Meridian Health, our team members are the heart of what makes us better. We help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members who keep getting better, advancing our mission to transform healthcare and serve as a leader of positive change.

The Patient Access Analyst, Oncology provides assistance to patients, physicians, and caregivers in all areas of Oncology/Radiation Oncology services within the HMH healthcare system. This role focuses on prior authorization for oncology services and specialized services requiring prior approvals to avoid revenue loss and unexpected out-of-pocket costs for patients. The position coordinates all functions related to patient precertification/authorization for chemotherapy, radiation, and diagnostic imaging, ensuring accurate registration, insurance verification, and navigation of insurance portals for clinical data submission.

Responsibilities

• Obtains referrals/authorizations and verifies eligibility, submitting requests for prior authorizations for all oncology services as prescribed by the clinical care team in conformance with Hackensack Meridian Oncology/Radiation standards and protocols.
• Submits referral information to necessary providers as appropriate.
• Assists with pre-authorizations for hospital admissions, procedures, medications, and medical equipment.
• Maintains ongoing communication with insurance companies to determine eligibility, deductible status, and to obtain precertification for office-based and other procedures.
• Educates and informs patients and families regarding verification status, deductibles, co-payments, and balances.
• Responds to hospital staff and/or patient inquiries regarding referrals, authorizations, and scheduling efficiently.
• Resolves all outstanding alerts on pending appointments within 48 hours, including missing referrals, precertification/authorization, self-pay accounts, eligibility verification, and missing demographic/insurance information.
• Determines if appointments need rescheduling due to missing referrals or authorizations and works with supervisors/clinicians to assess medical necessity.
• Notifies patients if appointments need rescheduling due to missing referrals/precertification/authorization.
• Analyzes patient medical records to ensure all clinical information is documented and gathered for insurance review.
• Reviews newly created treatment plans (radiation, pharmacy, or complex services) and cross-references insurance benefits to determine out-of-pocket calculations.
• Summarizes pertinent information in Epic Insurance Benefits verification notes to accurately communicate out-of-pocket expenses to patients.
• Documents both in-network and out-of-network benefits to ensure accurate communication to patients.
• Makes referrals to financial counselors when appropriate.
• Maintains regular communication with patients' clinical care teams and identifies modifications to treatment plans using the Epic Beacon Pharmacy work queue.
• Obtains new prior authorizations when needed to avoid technical denials.
• Understands payer rules governing prior authorizations for treatment plan changes and follows Medicare rules for medical necessity.
• Informs patients of options as defined by the Advance Beneficiary Notice (ABN) in alignment with Medicare guidelines.
• Documents prior authorization requirements by CPT or J code to ensure clarity for pharmacy and patient financial services.
• Communicates whether treatment plans meet medical necessity, regardless of prior authorization requirements.
• Acts as a liaison between financial counselors and assigned vendors, documenting estimated out-of-pocket costs, treatment status, and authorization status.
• Provides clarification to clinical care teams regarding drug coverage and approval by insurance.
• Acts as a liaison between vendors and patients to obtain necessary signatures and documents in Epic.
• Inputs proper documentation into the Beacon referral shell to ensure approved drugs are used and financial risks are mitigated.
• Obtains prior authorizations for diagnostic imaging and outpatient services for oncology patients and others as ordered by attending physicians.
• Reviews accounts to ensure proper CPT codes are billed accurately and timely to insurance carriers.
• Prioritizes bed assignments in accordance with policy and ensures patients are assigned to the proper unit.
• Reviews orders to ensure patients are in the appropriate status and level of care.
• Initiates real-time eligibility queries (RTE) on eligible insurances and reviews responses for correct plan code assignment and coordination of benefits.
• Ensures accurate completion of the Medicare Secondary Payer Questionnaire.
• Performs insurance verification for all inpatient and outpatient services and determines out-of-pocket responsibility using the EPIC Financial Estimator tool.
• Pursues upfront cash collections to assist patients in understanding financial responsibilities and minimize bad debt.
• Informs patients of their out-of-pocket responsibility, accepting payments via credit card or in person, and explaining financial resources such as assistance, payment plans, or payment on the date of service.
• Verifies benefits to ensure procedures are covered under the patient's plan prior to service and follows up with referring physicians and payers for authorizations.
• Submits all data timely and expeditiously to ensure authorizations are obtained prior to the date of service.
• Ensures diagnosis data entered on registration is accurate and meets medical necessity criteria.
• Complies with HMH's patient financial responsibility and collection policies.
• Provides patients with appropriate administrative information as directed.
• Maintains compliance with federal/state requirements and ensures signatures are obtained on all required regulatory/consent forms.
• Manually registers patients accurately during downtime and follows proper registration input procedures when the system becomes available.
• Mediates daily scheduling, pre-registration, precertification, or registration issues and escalates unresolved issues.
• Completes assigned work queue (WQ) accounts in a timely and efficient manner.
• Identifies the needs of the patient population served and modifies care delivery accordingly (e.g., age, culture, language, hearing, or visual impairments).
• Ensures delivery of excellent customer service resulting in a positive patient experience.
• Complies with all procedural workflows and departmental policies and procedures.
• Scans documents and correspondence from patients and payers.
• Coordinates daily activities of the Patient Access Department to foster an environment promoting patient comfort and trust.
• Schedules patients as needed and handles a high volume of phone calls professionally.
• Ensures timely notification of admission to payers and refers accounts to Case Management for timely submission of clinical information.
• Verifies eligibility and benefits to ensure coverage is active and procedures are covered prior to the date of service.
• Accesses and navigates payer websites (e.g., Navinet) to confirm insurance coverage and policy benefits.
• Works with patients to financially clear their accounts per policy at least 3 days prior to procedures and resolves coverage issues.
• Processes all acceptable payment methods (cash, check, money order, credit card) accurately and reconciles daily cash drawer or shift transactions.
• Completes pre-registration for all appropriate patients in Epic and sets account status to "Confirmed pre-reg."
• Contacts patients and/or physicians' offices regarding Pre-Admission Testing scheduling.
• Obtains patient records and processes scheduling information, including copying, filing, faxing, and answering phone calls professionally.
• Works in all Access Services areas within the hospital and may rotate shifts as needed.
• Checks email daily for updates on process/task changes and meets departmental productivity and process standards.
• Performs other duties and/or projects as assigned and adheres to HMH organizational competencies and standards of behavior.

Qualifications

• Associate's degree and/or related work experience.
• Minimum of 3 years of experience in a hospital setting or medical/clinical office.
• Prior experience with an electronic health record system (especially EPIC clinical or ARIA) preferred.