The CSI Companies is a national professional recruiting firm that is currently seeking a Patient Services Financial Representativeto support one of our clients, a highly respected and well-known non-profit healthcare organization in the Orlando/Maitland, FL area.
Shift: M-F 8A - 5P
The Patient Services Financial Rep, under general supervision, maintains performance standards appropriate to area by obtaining account benefits and/or verifying authorizations are in place for all chemotherapy regimens and treatments, and meeting time line standards established by leadership for all patient services.
S/he meets or exceeds department audit accuracy and productivity standard goal. Uses utmost caution that obtained benefits, authorizations, and/or pre-certifications are accurate according to the actual test, and procedure or registration being performed.
KNOWLEDGE AND SKILLS REQUIRED:
- One (1) year experience in Patient Financial Services, Patient Access, Customer Service or related area (registration, finance, collections, customer service, medical office, or contract management)
- Ability to use discretion when discussing personnel and patient related issues that are confidential in nature
- Responsive to ever-changing matrix of hospital needs and acts accordingly
- Self-motivator, and quick thinker
- Proficient in Microsoft Office Programs such as Outlook, Word, and Excel
- Proficiency in performance of basic math functions, capability of communicating professionally and effectively in English, both verbally and in writing
- Associate’s Degree and/or higher-level education or completed coursework
- Clinically relevant certification such as Medical Assistant, Patient Care Tech or Pharmacy Tech
- Two (2) years’ experience in Oncology related business operations within specialty pharmacy, insurance verification, payor reimbursement guidelines, and/or authorization submission.
- Familiarity with medical terminology and concepts.
- Working knowledge with third party insurance administrators authorization and clinical care processes.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
- Responsible for review and coding of chemotherapy regimen/treatment orders. Review of structured clinical data matching against insurance payor and/or National Comprehensive Cancer Network (NCCN) guidelines.
- Ensuring specified medical terms, diagnosis, medication codes and supporting clinical documentations are met.
- Utilization review to facilitate the sending of clinical information in support of the authorization to payor or third-party administrators, as assigned.
- Responsible for communicating to service line partners of situations where medical necessity is not met to include review of journal articles, compendia and/or peer review to justify medical necessity approval.
- Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
- Accurately enters required authorization information in systems to include length of authorization, total number of visits, and/or units of medication.
- Responsible for denial notification to clinical counterparts, meeting strict timely notification standards.
- Completes patient estimates for chemotherapy regimen/treatment plan to include medication units, deductible, coinsurance and out of pocket maximums.
- Obtains PCP referrals when applicable.
- Meets or exceeds audit accuracy and productivity standard goals determined by Pre-Access leadership, while meeting timeline standards established by leadership for all patient services.
- Ensures integrity of patient accounts by working error reports as requested by management and entering appropriate and accurate data.
- Provides timely and continual coverage of assigned work area in order to offer prompt service to partners.
- Assists with authorization initiation process if needed.
- Meets attendance requirements, and maintains schedule flexibility, as required.
- Exhibits effective time management skills by monitoring time and attendance to limit use of unauthorized overtime.
- Uses utmost caution that obtained benefits, authorizations, and pre-certifications are accurate according to the actual chemotherapy regimen/treatment and procedures being performed.
- Ensures all benefits, authorizations, pre-certifications, and financial obligations of patients, are documented on account memos, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts.
- Conducts diligent follow-up on outpatient and inpatient authorization accounts with third party payers to minimize authorization related denials through phone calls, emails, faxes, and payer websites, updating documentation as needed.
- Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services departments.
- Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related Pre-Access account issues, within defined time frames.
- Exhibits effective time management skills and maintains flexibility by being available for all partners and team.
- May assists team with reports and projects to maintain team and individual productivity standards and goals.
- Works patient accounts for benefits, monitors accounts for change in chemotherapy regimen/treatment status prior to registration and sends updates to appropriate areas for follow up.
- Works patient accounts for pre-certification, contacts physician, Patient Access staff, and clinical service area where appropriate.
- Notifies Patient Access (Financial Advocates) when authorization is not obtained by department deadline, advising of possible denial.
- Exhibits effective time management skills in completing these tasks.
- Maintains a current and thorough knowledge of utilizing online and system tools available, working from manual reports during system downtime.
- Maintains sign-on access to online tools to provide consistent service to patients, clinical partners, and Patient Access team members.
- Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
For additional information, please apply!