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…