Pfs Financial Counselor Level 2 Cancer Center

Summary/Objective

The Financial Counselor provides guidance and support to cancer center patients and their families. The role is responsible for verifying insurance, estimating out-of-pocket costs, assisting with financial assistance programs, and helping patients understand their benefits and payment responsibilities. The goal is to minimize financial barriers to care and enhance the patient experience.

Essential Functions

• Acts as a liaison between the office, social worker, front desk and the patient to answer any questions/concerns regarding cancer center policies and procedures. Maintain thorough documentation of all financial counseling interactions. 
• Review financial obligations and explain the billing processes in a clear and compassionate manner. Confirm insurance coverage and verify whether the clinic is in-network with the patient’s plan. Provide patients with accurate estimates of out-of-pocket expenses for treatments, medications and procedures. Contact patients when necessary to set up payment plans on any outstanding balances. Review patient account balances. Assist with resolving denied claims or billing issues in collaboration with the revenue cycle team.
• Follow accounts monthly to ensure payments arrangements are kept and if not, flag appts to see patients at their next appointment.
• Monitor patients’ accounts to ensure insurance changes are updated timely and all clinic departments involved in patient care are updated via CCCR email groups.
• Screen patients for financial assistance eligibility and help complete necessary paperwork for Medicaid or Foundation assistance. Medicaid plans must be verified monthly through the CMS website including Dual Complete or Share of Cost plans.  
• Responds timely to Guest Navigator staff scheduling patients for NOI, Medicare Only, or collection balances after contact is made with the patient to advise of balance to be resolved or estimated patient responsibility for visits. 
• Responds to any managed care concerns regarding expired insurance plans. Contact patient for current insurance information and master it into Epic, notify the CCCR email groups advising of insurance updates, asap.
• Attend weekly CCCR meetings to collaborate with physicians, clinical care teams and administrative staff to coordinate the financial aspects of care.
• Drug order financial approval process:
• Drug orders from Intellidose require financial approval processing. All drugs included in the order must be reviewed on NCCN to determine if the diagnosis code on order is payable as 2A or 1. If information unavailable then other sources such as CMS and the drug’s billing and coding guides are utilized. If diagnosis code with drug not found to be payable, communicate the information to the physician’s office.
• The patient’s financial account is reviewed for good standing. If there is a large self-balance or collection balance, steps will be required to determine clearance.
• Insurance advising buy and bill information, must be called for drug specific benefits, or must call for self-injectables; then insurance is called for the benefits with drug codes and diagnosis codes.
• Benefits in Epic and codes are shown as payable and estimated cost is worked up in McKesson.
• All the information gathered is put into a note in Epic labeled Chemo Estimate or Chemo Clearance. 
• Patient contact required and agreement to pay the estimated responsibility obtained then an email is sent to the process and the scheduler

High school graduate or equivalent. Basic knowledge of Patient Financial Service department responsibilities including Medical Insurance, Verification, EOB information, patient payments, and Insurance receipts. Demonstrates tact handling situations with personnel and patients. Able to communicate ideas in a clear and concise manner. Possess good organizational skills. Ability to assess a situation and decide on the best course of action. Has excellent communication skills, oral and written.

PREFERRED.

Experience or knowledge with Medical Insurance EOB review, Insurance Verification of Eligibility, Processing Patient and Insurance Payments, and Review patient accounts for accuracy.