Specialist, Financial Counselor - Oncology Financial Navigation

About the role

Under limited supervision, assesses financial needs of new and established oncology patients based on specified treatment protocols. Determines liability on patient accounts, works with patients or their representatives to provide financial assistance, and facilitates processing of Medicaid and other financial assistance applications. Provides patient and health care team education and links to resources. Also responsible for data collection, initiating eligibility determination for the Health System's charity care fund, and resolution of accounts receivables.

Our Trinity Health Culture

Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus

Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.

Process Focus

Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis

Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts. Maintains a working knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects safe, honest, ethical & professional behavior & safe work practices.

Functional Role

• Provides patient counseling regarding treatment costs, insurance coverage, available payment resources, and financial assistance options. Secures and documents payment arrangements.
• Submits authorization for initial and subsequent high-cost infusion and oncology services based on complex treatment plans. Coordinates with the patient, physician, insurance company, and pharmaceutical company to complete the required pre-authorization process.
• Validates payable diagnosis codes/medical necessity and prior therapy requirements according to FDA and NCCN guidelines.
• Assists patients in financing, payment plans, financial assistance and all financial options through the organization. This includes grants, co-pay assistance for high-cost pharmacy/drugs and free-drugs for infusion and specialty care patients.
• Monitors assigned patient accounts through entire revenue cycle to ensure copay program claims, payments, denials, and other assistance programs are being processed properly.
• Assists with ordering, tracking, and reporting of all free drugs obtained.
• Collaborates with the treatment team on the financial implications of medical intervention to the patient and the health care provider.
• Responsible for case management of complex financial clearance needs for patients and elevates cases as appropriate.
• Works closely with RSO and division leadership to improve collections.

Minimum Qualifications

• High school diploma or GED.
• Minimum two (2) to three (3) years experience working in Patient Access or Patient Accounting for hospital registration and / or hospital reimbursement services.
• Obtain National certification in HFMA CRCR and/or NAHAM CHAA required within one (1) year of hire.
• Understanding of basic billing and coding.

Preferred Qualifications

• Bachelor's degree or advanced certification or a combination of advanced training and/or certification (e.g., Registered Nurse, Licensed Practical Nurse, Certified Pharmacy Technician, Registered Health Information Technician, or medical coding certification through AHIMA or AAPC).
• Epic Experience Preferred.
• Knowledge of federal or state government agencies including but not limited to Medicare, Medicaid, VA or Charity Care programs, or patient management and healthcare accounts receivable within the healthcare revenue cycle.

Physical & Mental Requirements & Working Conditions

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
• Exposure to interruptions, shifting priorities & stressful situations. Frequent
• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Frequent
• Ability to read small print, hear sounds & voice / speech patterns, give & receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Continuous
• Perform manual dexterity activities & / or grasping / handling. Continuous
• Ability to climb, kneel, crouch & / or operate foot controls. Frequent
• Use a computer / other technology. Occasional
• Sit with the ability to vary / adjust physical position or activity. Continuous
• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous
• Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Frequent
• Ability to provide assistance in the event of an emergency. Continuous

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Frequent
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
• Lift a maximum of 30 pounds unassisted. Occasional
• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
• Encounter a clinical / patient facing / hands on interactive work environment. Frequent
• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
• Work outdoors with variable external environmental conditions. Occasional