Req ID: 5982
Employment Status: AF - Active - Regular - Full Time
The Financial Liaison acts as a centralized resource for families to gain support and education regarding the anticipated out of pocket costs of a new cancer diagnosis. They also serve as an expert on insurance verifications and authorizations when necessary for care coordination. They provide financial counseling to patients, families, and to the providers delivering care. The liaison works closely with in-patient and out-patient clinical staff, Patient/Family Education Specialist, PSR s, Research Coordinators, Insurance Specialists, Schedulers, and Social Workers from the point of the initial referral and throughout the treatment continuum. The liaison maintains and develops positive relationships and clear lines of communication with insurance representatives from multiple insurance companies who can provide precertification/authorization guidelines unique to the individual insurance plan. Works with health insurance providers to determine coverage, benefit limits, and financial responsibility and conveys this information to the clinical team, patient, and family. Networks with peers at other Centers, and internal precertification/insurance employees across CHOP s billing entities to stay abreast of and share recent changes, updates, and processes. Acts as a liaison between CHOP billing entities and oncology patients. Provides complete information to the Single Case Agreement Team on initial request, to facilitate a standardized process for non-par insurance plans rate negotiations. Strong communication skills, attention to detail, and a high level of organization are critical qualities. Possesses a high level of customer service and commitment to providing customer service excellence partnering with the children and families we serve.
1) Counsels, Educates, and Coordinates with families regarding insurance coverage plans.
- Obtains detailed patient insurance benefit information for all aspects of the treatment process from point of initial referral.
- After initial contact with patient/family, the liaison partners with Insurance Specialists to obtain authorizations.
- The liaison works closely with the family to schedule initial appointments once authorized.
- Partners with Social Worker and Patient Navigator to connect families to available resources to assist with financial obligations/ hardship; and processing applications for free care, special pharmacy benefits, etc.
- Prepares analysis of insurance plan, capitation information, co-pays, and deductibles and reviews anticipated out of pocket expenses with families. Assesses financial impact on families and collaborates with Patient Navigator and Social Worker to seek available resources. Informs clinical staff about coverage information, such as capitations and limited authorizations.
- Interacts with every patient and/or family who has a new cancer diagnosis (in person within 30 days of diagnosis). Ensures that communication is ongoing so that changes in coverage can result in updated review.
- Participates in new patient/ family education process partnering with the Patient/Family Education Specialist and Nurse Navigators.
- Partners with patients, their families, and team members to address insurance coverage gaps via alternative funding sources.
- Acts as central contact for families who have billing questions; facilitates resolution of issues.
- Communicates with family and/or guarantor, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or guarantor.
- Respond to all emails and answers all telephone calls promptly
- Provides comprehensive explanations of covered and non-covered services
- Contacts appropriate clinical staff in timely manner with all information that requires follow-up.
- Develops and maintains systems to streamline communication with staff on all aspects of insurance
- Completes abbreviated assessment to determine family eligibility for Family Health Care Coverage programs and refer to FHCP when appropriate.
- Provides coverage to Insurance Specialists, as needed.
Job Responsibilities (Continued)
2) Responsible for coordinating and clarifying patient specific financial aspects of care to Oncology Providers
- Communicates proactively and directly with the patient s care team primarily the Intake Coordinator and Insurance Specialists - regarding status of authorization and the need for clinical documentation.
- Enters or checks patient registration demographics and makes corrections as needed.
- When providing coverage for Insurance Specialists, obtains all necessary payor authorizations for oncology care. Verifies coverage and other medical benefits and acquires necessary referrals and authorizations. Obtains or confirms pre- authorizations for procedures.
- Obtains care referrals for office visits.
- Verifies coverage and benefit information via electronic eligibility or by contacting the payer
- Document all relevant information into EPIC
- Partners with Single Case Agreement Department for non-par referred patients, to facilitate negotiated rates for non-par payors.
- Responds to incoming calls regarding account status from patients and insurance companies.
- Partners with Revenue Cycle and billing to collect any backlogged revenue using billing WQ.
- Works to identify insurance trends and potential financial barriers to care and reports such issues to program administrator.
3) Registration Responsibilities
- Updates patient record by verifying demographic, insurance information, or proper study identification in the registration system.
- Ensures specific registration fields are accurately inputted into registration system, including but not limited to visit notes, referral/authorization numbers, eligibility review, proper payer plan entries for research and standard-of-care visits.
- Verifies coverage through Navinet/Passport, etc. and pulls appropriate referrals.
- Educates and informs family of outstanding financial obligations if appropriate. Collaborates with Social Work team. Provides documentation in Guarantor s Notes in Epic.
Job Responsibilities (Continued)
Required Licenses, Certifications, Registrations
Required Education and Experience
- Associate s degree required.
- Minimum of five years related healthcare registration, billing and/or reimbursement experience required.
- Advanced insurance authorization and registration techniques required
- Previous experience in complex clinical setting that required coordination of multiple services
- High level of interpersonal skills with excellent customer service and responsiveness
- Background in medical terminology
- Strong customer service orientation and experience required
- Ability to multi-task and prioritize is crucial to success in the position
Preferred Education, Experience & Cert/Lic
- Bachelor s degree preferred.
- Complex scheduling experience preferred (e.g. ancillary testing)
- Background in medical terminology, preferably in an Oncology experience preferred
Additional Technical Requirements
- Strong communication skills; must be able to communicate courteously and effectively with physicians, payors, and staff.
- Must be self-motivated
- Individual must be highly organized and dependable
- Ability to prioritize and work on several projects at once while maintaining communication with all invested parties.
- Ability to complete multiple tasks and work under pressure
- Ability to work with stressful situations while retaining a calm demeanor
- Ability to quickly learn new procedures.
- Strong computer skills.
- Strong customer service skills
- Ability to display compassion and empathy
- Ability to maintain confidentiality of patient information.
- Website Insurance Training (Navinet, WebMD, Passport)
- EPIC training and testing (Prelude/Cadence) preferred
Associated topics: ancmg, breast, cancer, hem onc, lah, oncology, palliative, physician md, physician md do, radiation
• Post ID: 46165182 southjersey