The Financial Counselor ensures that chemotherapy (specialty group) and other infusions/radiation therapy/radiology/ surgical services meet medical necessity and appropriateness per insurance medical policies/ FDA/NCCN guidelines. Initiates and coordinates pre-certifications/prior-authorizations per payer guidelines prior to services being rendered. The Financial Counselor counsels patients regarding their financial responsibility for treatment, educates and initiates enrollment in third party assistance programs that reduce patients' out-of-pocket expenses. Initiates enrollment in the Baptist Financial Assistance Program for self-pay patients and serves as a liaison between the patient and the Patient Assistance Team. Collects deductibles, co-insurance and prior balances and initiates payment plans. Performs other duties as assigned.

• Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according to insurance medical policy/FDA/NCCN guidelines and requirements.
• Research insurance company medical policies, medical literature, and compendiums to determine eligibility for services. Utilize multiple healthcare websites
• Review patient medical records and identify necessary information for pre-certification for confirmation of medical necessity
• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner
• Meet with new patients to provide patient-specific education on their insurance benefits and estimated out-of-pocket expenses for their prescribed therapy prior to treatment initiation
• Works with patients and caregivers to collect deductibles and co-pays and set up payment plans.
• Obtains necessary consent forms and financial documents from patients and providers to initiate applications for copay assistance and PAP drug programs
• Assists self-pay patients with initiating applications for the Baptist Financial Assistance Program.
• Works closely with physicians and clinic staff to promote positive patient outcomes and timely treatment
• Understands and complies with regulatory requirements by specific insurance companies and facilitates compliance by maintaining awareness of guidelines and ensuring compliance through communication and documentation to appropriate staff.
• Performs other duties as assigned.

Education

 Preferred:  Associates degree or 2 years of college level courses.

 Minimum:  Skill in communicating clearly and effectively using standard English in written, oral, and verbal format to achieve high productivity and efficiency. Skill to write legibly and record information accurately as necessary to perform job duties.

Experience

 Preferred:  5 years of business experience in a healthcare environment. Front-end collections experience desired.

 Minimum:  3 years of business-related office experience with 1 of those years being healthcare related experience.

Licensure, Registration, Certification

 Preferred:  CHAA

Special Skills

 Preferred:  Knowledge of oncology pre-certification requirements and guidelines.

 Minimum:  Ability to read and understand medical policies, compendiums, LCDs, and FDA guidelines. Must be able to multi-task and be flexible. Basic computer skills, ability to perform basic math computation, type 25 words per minute, and problem-solving skills. Dealing with confrontational issues and high stress situations with patients, family, and physicians.