The Patient Financial Advocate serves as the primary contact for obtaining pre certifications/ pre authorizations and insurance eligibility for patients regarding the chemotherapy or cancer related drugs. Also assists in enrolling patients with financial needs in drug assistance programs. Maintains/develops knowledge base of patient assistance programs related to chemotherapy. In addition, they are responsible for determining patient benefits prior to their appointments. Ensures correct charge entry for office visits and inpatient rounding. Reviews and corrects TES edits in Flowcast system prior to sending claim. Answers and directs patient questions regarding billing and insurance. Calls patients with balances and attempts to collect payments from bad debt list provided by Meridian. Individual must maintain and promote an attitude of professionalism as reflected by courteous actions, maintenance of confidentiality and appropriate presentation of self; consistently demonstrate excellent oral and written communication skills; possess the knowledge and skills necessary to provide interactive communications appropriate to the age of the patient being served; interact appropriately with third party payers, peers and other departments; and have the ability to relate well to people of a broad socio-economic mix.
High school diploma
De-escalation training, if applicable
Associates Degree in business administration or healthcare related field. If no degree, candidate must agree to attend an accredited higher educational institution that offers a business administration or health care related field degree.
2 years in a healthcare related field; knowledge of basic pre-certification/prior authorizations, registration and third party payer experience. Demonstrated ability to read, write, arithmetic, multiplication/division including fractions and decimals. Strong computer skills, excellent customer service skills and interpersonal communication and telephone etiquette are required. Demonstrate ability to multitask and manage high volumes. Computer, fax machine, copier, multiline telephone. Medical terminology, and basic knowledge base of CPT and ICD-9 and ICD-10 codes, insurance coding and billing knowledge. Knowledge of Microsoft Office.
4 years in a healthcare related field, with majority of focus working with third party payers. Experience in oncology/chemotherapy.
Verify insurance eligibility for oncology treatments- including infusion.
Obtain pre-certification/prior authorization for all oncology related treatments.
Assist patients with enrolling in drug replacement programs.
Review bad debt list and attempt to collect payments.
Communicate with patients to resolve current and prior patient liability prior to service.
Communicate with nursing staff and physicians to obtain any clinical documentation to obtain authorization for oncology related treatment.
Enter charges for physician visits and hospital rounds.
Answer and direct patient questions regarding billing or insurance.
Erlanger Medical Center