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Job Summary
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Oncology Financial Navigator initiates and coordinates pre-certification and prior authorization for patients with their insurance carrier. Provides financial counseling to patients and works closely with the business office to ensure timely claim and account follow up. Additionally provides administrative support to the outpatient infusion center care team.
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Minimum Qualifications
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Education/Training
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High School diploma or general education degree (GED) required.
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BA/BS degree preferred
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Experience
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Minimum 3 year related experience in a health care environment requiring excellent customer service skills and knowledge of medical terminology. Medical insurance experience required.
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Intermediate knowledge of Microsoft Office products, including WORD and EXCEL
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License/Certification/Registration
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Knowledge, Skills & Abilities
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Ability to read and interpret basic correspondence. Ability to speak effectively and communicate with physicians, patients, and other staff members
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Ability to add, subtract, multiply and divide all units of measure, using whole numbers, common fractions, and decimals.
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Primary Duties and Responsibilities
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Patient Registration/Admission:
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Coordinates patient registration, collects patient demographic and insurance information.
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Obtains authorization from insurance carriers.
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Generates all registration and admission paperwork required for procedure.
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Presents appropriate forms to patients, provide explanation/answers questions to patient/family, and obtains appropriate signatures.
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Maintains communication with physician, clinical coordinators, and patient/family on next steps as appropriate.
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Collects copays as appropriate.
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Responsible for charge entry, and daily reconciliation of charges, for services provided.
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Work with Patient Financial Services to investigate concerns/issues around insurance denials; Assist with resolving issues.
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Coordinates with the patient, physician, insurance company on the entire precertification process, including second opinions and tertiary referrals:
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Conducts new patient financial meetings to educate the patient regarding billing and insurance practices, help patients to navigate insurance and payment issues
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Discuss liability, and develop financial payment plans with patients after drug reimbursement, pharmaceutical patient assistant programs, and other assistance available to defray OOP patient liability.
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Monitor and track relevant insurance changes which affect patient financial liability.
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Coordinate financial documentation processes for Oncology Services:
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Complete patient financial liability estimates based on gaps in patients coverage; highlight gaps that will contribute to the patients out of pocket expenses
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Monitor outstanding balance sheets for all established patients to discuss payment, financial planning and assistance, as needed.
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Process additional information requests and work with insurance billers on requests for letters of medical necessity to/from insurance companies.
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Develop relationships and works with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.
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Identify potential resources to assist patients with financial costs of oral medication prescriptions that may be dispensed during treatment.
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Organizational knowledge: Works effectively within and between departments
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Greets all visitors, (patients, vendors, hospital personnel, etc.) answers their inquiries, gives directions, and provides general assistance.
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Participates on inter-departmental teams and committees, communicating knowledge as appropriate.
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Provides department/unit with information and knowledge acquired during participation with interdepartmental teams and committees.
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Demonstrates a constructive approach during all interactions with staff, and managers both inside and outside the hospital.
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Orders supplies as needed for the department
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Participates in departmental preparation for Joint Commission and other regulatory site visits. Collaborates with Division team to ensure the physical environment is maintained
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Performs other duties as assigned of a nature similar in scope and responsibility to those listed above.
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#IND123
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.