Patient Financial Advocate

About the role

The Patient Financial Advocate advocates for financial assistance for patient treatments and medications by providing access to drug assistance programs. Reviews orders and checks for authorization of insurance payments. Ensures appropriate medical necessity of treatments as it pertains to insurance payment. Works collaboratively with the patient, the clinical treatment team, and various departments to establish a financial plan of action that minimizes the financial liability incurred by patients while facilitating the patient's timely access to care. Job Description: Schedule: Day Shift, No Weekends, No Holidays Located in Appleton KEY ACCOUNTABILITIES: Uses knowledge of current payor requirements, medical necessity, and medical coding to request authorization to determine if services are reimbursable. Reviews daily revenue sheets and makes corrections as needed. Performs pre-authorizations for services per insurance requirements. Understands services provided while utilizing NCCN guidelines to ensure accurate and timely claim submission. Ensures accurate documentation of verification of benefits and authorization of services. Ensures proper documentation for Medicare and bundling compliance to achieve accuracy of patient charges and correct reimbursement for services rendered. Serves as subject matter expert to providers and others regarding documentation requirements for accurate charge capture. Demonstrates ability to act with sensitivity to assist and inform patients about costs of services integrated with the patient's insurance coverage and limits. Reviews patient financial/insurance considerations and collaborates with multiple providers, payors, and patient accounting as appropriate to effectively and efficiently obtain proper authorization for services. Contacts and/or meets with patients to discuss pre-authorization outcomes, billing questions, denials, or concerns. Refers patients to patient accounting as appropriate. Supports patients in obtaining foundation/grant money to aid in medication coverage or refers them to other financial support services when need is identified.