Financial Services CoordinatorBusiness Specialist

Financial Services CoordinatorBusiness Specialist 3.8 3.8 out of 5 stars Somerset, NJ 08873 Full-time ProCure Proton Therapy Center 18 reviews Full-time The Financial Business Specialist (FBS) is a part of the multidisciplinary team responsible for providing accurate and professional clearance, reviewing demographics, employment and insurance data necessary for payment of proton therapy treatment and verifies insurance coverage and benefits for our patients. Assists patients with financial counseling related coverage / reimbursement of proton healthcare related expenses. Assures that patients are financially cleared prior to patients being scheduled for consultations/simulations and that there are not any outstanding balances prior to clearance. May assist in collecting co-payments and payments prior to and during treatment. Communicates directly with physicians as required.

RESPONSIBILITIES

: Verify insurance benefits / financial information through a variety of means, ensuring that all insurance data, referrals, and authorizations provided are current, accurate, and not approaching expiration. Determine the insurance policy coverage regarding proton beam radiation therapy, including, but not limited to, treatment site, diagnosis, clinical and testing prerequisites, limits of coverage, patient OOP responsibility, co-pay's, referral, pre-authorization, and pre-determination requirements, etc. Track and include the

BID/QUAD

cases on the authorizations to ensure continuous treatment coverage. Document necessary approvals/denials from patient payer sources in both Mosaiq (MQ) and Vantage. Review Vantage pipeline list daily for new patient's pending verification of benefits and submission of authorization/pre-determination. Educate patients on the insurance approval process for proton beam radiation therapy and any associated ancillary services needed from partner facilities (i.e., Anesthesia). Provide explanations and/or guidance on insurance coverage and/or our available financial resources for patients. Cross train to all areas of FBS responsibilities including finance appointments and collections of payment in the clinic area. Enter insurance information into MQ. Communicate directly with patients to relay their OOP/SPR responsibility. Perform job activities using Electronic Medical Record (EMR), MQ and maintain the paperless patient insurance record. Act as primary insurance interface between the Center and the partner physician practice(s). Maintain current knowledge of Radiation Oncology insurance requirements. Offer process improvement ideas regarding insurance and financial clearance to enhance patient satisfaction and improve current workflow. Timely record accurate insurance/billing information in MQ. Communicate clearly and effectively to team members and physicians regarding patients out of pocket expenses. Close the loop with the Patient Service Specialist department regarding financial clearance and scheduling. Review daily Capacity List regarding up-to-date financial clearance status. Ensure direct communication with the Director, Commercial Payer Contracting. Ensure notification via email for all patients with NY/NJ Managed Medicaid plans to obtain "Single Case Agreement (SCA) or a Letter of Agreement (LOA) as required. Track any change in patient treatment status. i.e. patients on break/hold, re-treat patients, treatment fraction changes and verify if the authorization on file covers said changes. Review the buckets in Vantage to verify if any re-treat patient is listed under the "Payment to Patient" tab with an outstanding balance. Notify patient of outstanding balance that must be paid in full prior to start of new treatment. Verify and update insurance benefits for all patients treated into the New Year, typically called the "rollover period". Communicate to the patient their OOP responsibility and payment expectations prior to consult / sim appointment. Responsible for sending the financial clearance email to the physician, Finance Department, Patient Service Specialist department, and scheduling team. Possess a thorough understanding of utilizing the QCL process for creating, following up, and completing the QCL's with 100% compliance. Respond to all physician emails received prior to the end of business daily. Respond to phone call voicemails within 24 hrs. Meet with patient on day of consultation/simulation to review financial information previously discussed. Obtain patient signature on the "Patient Responsibility Agreement" and necessary appeal forms, confirming with patient that the insurance we have on file is current and no changes/updates are needed. Collect any payment due on date of simulation. Obtain authorization for any inhouse ordered PET CT, CT, and MRI exams. Schedule Peer to Peer's (P2P) with scheduling team for physicians for both PBRT and Radiology denials as needed. Able to adapt and change workflow with updated processes and procedures. Identify and contribute to Operational process improvement programs/initiatives to maximize efficiency and effectiveness of services provided. Other duties as assigned by Manager.

WORK EXPERIENCE REQUIREMENTS

: A minimum of two years of experience in healthcare insurance. Ideal candidate will possess experience with healthcare insurance processing and claims. Experience performing electronic registration, financial hardship applications, insurance eligibility and enrollment Experience interfacing with patients and their families regarding healthcare insurance coverage.

REQUIRED SKILLS AND ABILITIES

: Healthcare insurance / claims expertise Exemplary customer satisfaction skills, including dealing effectively with customers, both in person and over the telephone Proficient using Microsoft office products and electronic registration systems Excellent written and verbal communication skills. Understands ICD-9, ICD-10 and CPT coding Medical terminology Experience using Mosaiq / IMPAC software preferred Experience using NaviNet and Passport for prior authorization and benefits preferred Understands management of patient accounts via outsourced billing providers

COMPETENCIES

: Problem Solving/Analytical Skills Organization, Attention to Detail & Time Usage Performance Standards/Results Orientation Competency/Dependability/Thoroughness Interpersonal / Communication skills

EDUCATION/DEGREE

: HS Diploma or GED required College Degree preferred

Job Type:

Full-time Benefits:

401(k) Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Life insurance Paid sick time Paid time off Vision insurance

Work Location:

In person