As a member of the Oncology/Infusion team, the Infusion Finance Specialist manages and/or coordinates all financial issues with patients, insurers, referring/attending physicians, care coordinators, pharmacy staff, and other stakeholders related to medications administered in the clinic/infusion center. Verify insurance coverage; assesses level of benefits; obtains payer approvals for high cost drug therapies prior to patient treatment; solves problems with insurers; provides financial counseling and support for patients as needed during their course of treatment.
Accept and process all referrals, identify payer sources, verify benefit information and acquire initial authorization as needed to begin patient service or to determine denial of patient service. Follow up on pending unresolved coverage issues and claim denials. Document and communicate to appropriate providers and internal departments accurate authorization information on current or potential patients.
Provide superior customer service to all internal and external customers.
Responsibilities/Job Description
Using strong knowledge of insurance, revenue cycle and oncology infusion and accordance with department Standard Operating Procedures (SOPs) and any regulatory or compliance requirements: Perform verification of insurance benefits, analysis and identify any potential coverage issues Assure fast, easy access to infusion services while documenting accurate referral and reimbursement (payer) information, coordinating the intake and benefit authorization process Provide financial counselling and support for patients as needed during the course of their treatment communicating options for financial assistance as appropriate. Research to find other programs for payment and/or negotiate with providers and third party payers to provide coverage or exceptions. Assist in resolving problems with payers and provide information and expertise to other departments. Partner with potential international and self-pay patients on any financial or service needs related to their infusion care Coordinate with staff to identify appropriate patients for home and outpatient infusion therapy including payor source, clinical information, and the ability of Fairview Home Infusion to provide a safe environment for infusion therapy.
Serve as a resource to the affiliations, staff and physicians regarding Fairviews infusion services. Assist with the coordination of services by communicating effectively and in a timely manner with others.
Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
Qualifications
Required Education:
Bachelor's degree or equivalent experience
Experience:
2 years of revenue cycle, financial counseling (including prior authorization experience as a pharmacy tech) or contracting experience using an enterprise software system in healthcare or insurance organization.
Preferred Education and Experience:
Baccalaureate degree in business, communications, social work or health care.
2 years of revenue cycle, financial counseling or contracting experience using an enterprise software system in the oncology or infusion service line of a complex healthcare organization.
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.
