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Patient Financial Coordinator

3 months ago

Washington, Washington, D.C., United States MEDSTAR HEALTH Full time

MedStar Health is looking for a Patient Financial Coordinator – Cancer Institute to join our team at MedStar Washington Hospital Center.

As a Patient Financial Coordinator for the Cancer Institute, you will provide financial navigation for patients prior to treatment, which includes explanation of patient's financial obligations, billing practices, and referring patients to Central Financial Clearance for payment arrangements. Evaluates and explains insurance benefits to the patient to ensure they understand their coverage. Helps patients estimate out-of-pocket expenses. Determines need for additional coverage. Assists patients in obtaining outside financial assistance from public and private entities. Ensures all appropriate forms are filled out. Works closely with Central Financial Clearance as needed. Serves as the Cancer Institute liaison between patients, hospital and professional billing departments, and clinical operations to resolve patients' billing issues. Serves as an expert on oncology-specific treatment and related insurance coverage issues, including rules governing medical necessity. Is the Cancer Institute's expert on current and future healthcare insurance policies and trends related to cancer treatments and tracks these for each individual payer.

Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move


Education
  • Bachelor's degree in Healthcare Administration, Social Work, or related field required
Experience
  • 3-4 years of progressively more responsibilities and experience with healthcare insurance, including prior authorizations, insurance verification and/or claims adjudication, as well as health insurance policies and trends among major payers required
Licenses and Certifications
  • CCS-Certified Coding Specialist preferred
Knowledge, Skills, and Abilities
  • Management/financial skill base is required.
Serves as advocate and liaison between patients, private and federal payors, hospital clinical and financial personnel and community partners. Serves as liaison with facility and professional billing departments.Obtains patient insurance benefit information for all aspects of the treatment, including, but not limited to, outpatient prescription drugs, follow-up clinic visits, and travel and housing.Works with Central Financial Clearance to help patients understand any potential patient out-of-pocket liabilities.Advises patients if and when government programs are available and can be used in conjunction with other contracts. (especially Medicare, BC/BS, commercial payers).Works with patients, their families, social workers, clinical team members and Patient Financial Services to address insurance coverage gaps through alternative funding options.Assists patients with securing continued coverage during treatment cycles and avoid lapses in coverage.Presents patient financial profiles at meetings and succinctly presents financial issues with a recommended course of action for resolution.Interfaces with key insurance company representatives, including Case Managers and Medical Directors, to discuss protocol appropriateness and educates insurance company representatives regarding the necessity for care.Works closely with related departments to ensure completion of, and assistance with, the eligibility process and coordinates with these departments to ensure the patient's financial and social needs are addressed.In conjunction with inpatient coordinators, ensures prescription coverage availability during transitions of care between inpatient and outpatient care. Liaison with pharmacy to ensure timely distribution of medications.Provides expertise on current and future healthcare insurance policies for cancer treatments and trends and tracks such policies and trends for each individual payer. Maintains detailed knowledge of reimbursement and regulatory environment specific to cancer treatment and current written information about departmental billing practices and payer requirements. Communicates payer requirements with applicable clinical and administrative staff.Represents the department on various committees and task forces.Manages financial assistance grants and special purpose funds for financial assistance to cancer patients.