Financial Navigator- Oncology

Major Responsibilities:

Financial Assessment and Counseling

• Conduct comprehensive financial evaluations for oncology patients referred by providers, nurse navigators, financial counselors, social workers, and other members of the care team.
• Assess insurance coverage, financial hardship, and potential barriers to treatment adherence.
• Educate patients and families regarding insurance benefits, deductibles, copayments, coinsurance, out-of-pocket maximums, and estimated treatment costs.
• Provide individualized financial counseling to assist patients in making informed treatment decisions.
• Review and explain medical bills, insurance statements, and Explanation of Benefits (EOBs).
• Assist patients with establishing payment plans and identifying available financial resources.

Insurance Navigation and Coverage Support

• Verify and review insurance benefits related to oncology services, infusion therapy, radiation oncology, imaging, laboratory testing, specialty medications, and supportive care services.
• Identify gaps in coverage and collaborate with patients and payors to prevent treatment delays.
• Assist uninsured and underinsured patients in exploring available coverage options, including Medicaid, Medicare, Marketplace plans, charity care, and other programs.
• Collaborate with prior authorization and revenue cycle teams to address insurance-related barriers affecting treatment initiation and continuation.
• Support patients with insurance appeals and documentation when appropriate.

Financial Assistance Program Management

• Research, identify, and secure financial assistance resources for eligible patients.
• Assist patients with applications for pharmaceutical manufacturer assistance programs, copay assistance programs, foundation grants, and charity resources.
• Coordinate access to funding for oral oncology medications, infusion therapies, supportive medications, and other treatment-related expenses.
• Monitor availability of grant funding and proactively connect eligible patients with resources.
• Maintain expertise regarding local, state, federal, nonprofit, and disease-specific financial assistance programs.

Denial Management and Revenue Recovery

• Track insurance denials and reimbursement challenges impacting oncology patients.
• Analyze denial trends and identify opportunities for process improvement.
• Collaborate with revenue cycle and billing teams to support resolution of complex cases.
• Assist with gathering documentation required for reconsiderations and appeals.
• Maintain reports related to patient assistance outcomes, denials, and recoveries.

Care Team Collaboration

• Communicate patient financial concerns and interventions to physicians, advanced practice providers, nurses, nurse navigators, social workers, pharmacists, financial counselors, and other members of the oncology care team.
• Document all patient interactions, financial assessments, referrals, and outcomes within the electronic medical record.
• Participate in multidisciplinary meetings, case reviews, and oncology program discussions.
• Serve as a resource for staff regarding financial advocacy, insurance requirements, and patient assistance opportunities.
• Promote collaboration across cancer services to improve access and continuity of care.

Resource Coordination and Advocacy

• Connect patients with community resources for transportation, lodging, food assistance, and other support services that may affect treatment adherence.
• Advocate for patients experiencing financial hardship related to their cancer diagnosis and treatment.
• Assist patients throughout the continuum of care, from diagnosis through survivorship.
• Support efforts to reduce financial toxicity and improve the overall patient experience.

Program Development and Quality Improvement

• Maintain current knowledge of healthcare regulations, insurance practices, oncology reimbursement, and patient assistance resources.
• Participate in ongoing education, oncology program meetings, and financial advocacy initiatives.
• Assist leadership with program development and process improvement efforts.
• Track and report key performance indicators, including financial assistance secured, patient outcomes, denial recoveries, and resource utilization.
• Contribute to initiatives designed to improve access, reduce treatment delays, and enhance patient satisfaction.

Education/Experience

Required:

• High school diploma or equivalent. Bachelor's Degree preferred. 1-2 years in a medical setting or equivalent. 2-3 years of customer service experience in a high volume, multiple tasks, high stress environment, ability to multitask. Plus 1 year hospital or medical office collections or financial counseling experience. Experience handling difficult callers, customers and patients. Basic knowledge of managed care and commercial insurance.
  
  Basic knowledge of medical terminology and billing and coding practices. Familiarity with all third-party payors. Familiarity with IDPA eligibility for the MANG program. Previous verification experience
• Bilingual in Spanish preferred

Knowledge, Skills &…