Patient Financial Counselor -

Oncology Services Position Summary:

The Patient Financial Counselor (PFC) is responsible for initiating and coordinating pre-certification and acquiring prior authorizations for patients. The PFC will work closely with insurance carriers, to provide financial counseling to patients and to work closely the business office to ensure timely claim and account follow up. The PFC will coordinate with the patient, physician, insurance company, and CMC to complete pre-certification process, including second opinions and tertiary referrals. The PFC will be responsible for making and answering call from patients and insurance companies regarding the pre-certification processes, as well as process additional information requested and coordinate with the insurance biller on requests for letters of medical necessity. The PFC will receive and process insurance information and forms from patients and insurance companies. Additionally, the PFC will review provider and chemotherapy schedules, checking patients accounts for outstanding insurance claims over 60 days, while communicating with the biller to request additional claim follow up. The PFC will be responsible for reviewing patient chemotherapy protocols and determine insurance benefits and patient responsibility. The PFC will also work with pharmaceutical companies and other resources to obtain grants, financial aid and or free drugs for patients' in need. The PFC will assist in arranging payment schedules and discuss payment arrangements with patients for outstanding patient balances. All organizational staff, including this position, are specifically required as a condition of continued employment to make advance preparations for their families and pets in the event of weather emergencies such as Hurricanes and flooding threats. Any staff member can be determined as essential staff required to report to the facility during these events. In many cases this means reporting and sleeping at the facility before, during and after a weather emergency. By signing this job description, the staff member accepts this responsibility of readiness to report to work during any designated emergency staffing situation. CMC staff members operate as one team meeting the healthcare needs of our communities, thus this position will on occasion complete other duties as assigned beyond those designated in this primary job description which may include float coverage at an alternate facility, department or assignment. Qualifications Assessment of overall credit worthiness by review of a consumer credit report is required.

Education:

High school diploma required. Associates or Bachelor s degree in business related field preferred.

Experience:

One (1) years experience in hospital billing required. Previous experience in pre-certification and prior authorizations in a hospital setting highly preferred.

Special Skills:

Demonstrated proficiency with Microsoft Outlook, Word, Excel, Explorer required. Exemplary core customer service skills strongly required. Strong organizational skills required. Strong PC skills required. Strong verbal and written communication skills required.

Working Conditions:

Occasional exposure to difficult patients. Physical surroundings generally pleasant and comfortable. Generally contained office type environment. Most work performed while sitting, however, a moderate amount of walking and moving around within a confined area occurs.