Patient Eligibility Specialist Oncology

The best thing about this role

Are you looking to make a difference by improving the health of our patients?  Here you will find an innovative culture that is patient-focused and dedicated to making a difference.  We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible.

What you'll do

• The Patient Eligibility and Support is an integral member of the Bassett Cancer Institute, provides financial counseling and guidance for patients through various resources. Performs pre-determination of eligibility / authorization for selected treatments, procedures and visits prior to date of service. Determines self-pay status of patients and works closely with other Bassett clinical departments and support programs to assist patients in understanding and meeting financial obligations. Forms close working relationships with Cancer Institute staff, billing staff, and front-end staff assuring the best possible front-end processes for full and complete capture of revenue and patient services. Provides Presumptive Eligibility and Medicaid determination for patients. Assists patients in acquiring public health plans as appropriate. Works closely with local Departments of Social Services within Bassett’s service area as well as Bassett’s health plans and local Community Service organizations providing Facilitated Enrollment services.
• Provides complete Insurance Support Services to front end processes as well as to Bassett patients
• Determine eligibility status of assigned patients scheduled as self-pay within 5 business days of DOS
• Refer true self-pay patients to appropriate clinic staff as well as CSP program
• As appropriate determine self-pay patients' eligibility for other public insurance programs
• Provide presumptive eligibility and application assistance for appropriate patients as needed
• Verifies Medicaid status of selected Medicaid patients within 5 business days of DOS vides verification and eligibility status on "high ticket" outpatient procedures as assigned
• Work closing with CSP program, develops process to reduce MedSpar recalls from front end work
• Work closely with billing office to identify front end denial trends and develops intervention actions
• Provides coordination with the patient, insurance company, and hospital on the complete pre-certification process, which includes second opinions and tertiary referrals
• Process additional information requests and coordinate with the insurance biller on requests for letters of medical necessity from and to insurance companies
• Review patient chemotherapy protocols and determine insurance benefits and patient responsibility
• Assist with SSI or SSD
• Assist and/or process STD (short term disability) forms
• Assist with payment arrangements for patients with outstanding patient balances
• Assist fund management
• Assist patients with treatment cost analysis
• Educate patients about financial resources
• Assist with obtaining or understanding insurances
• Information Management
• Develop working knowledge of Bassett payer system and financial classifications
• Assist system administrators in providing coaching for end users on system data entry
• Maintain department specific data bases and data management processes
• Performs other duties as requested and observed by supervisor or manager

What we need from you

Education:

2 Year/Associate Degree in health related field, preferred

Experience:

Preferred minimum 3 years of work-related experience:

in healthcare, eligibility/verification processes and systems working with uninsured and Medicaid patients knowledge of NYS presumptive eligibility/facilitated enrollment processes knowledge of public health insurance programs and other community resources available to the disadvantaged experience working with diverse groups of individuals from a variety of cultural, socioeconomic and educational backgrounds

Experience in one-to-one counseling and coaching, preferred

Skills:

Accountability

Advocacy

Attention to Detail

Communication

Community Relations

Computer Skills

Networking

Responsibility

Time Management

Physical Requirements:

Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking or standing are required only occasionally, and all other sedentary criteria are met

Occasional grasping, lifting, pulling, pushing, reaching, standing

Frequent typing/clerical/dexterity, hearing, repetitive motion, seeing/monitor/computer use, talking, visual acuity (color, depth, perception), walking

Travel:

No travel required

Responsibilities

• The Patient Eligibility and Support is an integral member of the Bassett Cancer Institute, provides financial counseling and guidance for patients through various resources. Performs pre-determination of eligibility / authorization for selected treatments, procedures and visits prior to date of service. Determines self-pay status of patients and works closely with other Bassett clinical departments and support programs to assist patients in understanding and meeting financial obligations. Forms close working relationships with Cancer Institute staff, billing staff, and front-end staff assuring the best possible front-end processes for full and complete capture of revenue and patient services. Provides Presumptive Eligibility and Medicaid determination for patients. Assists patients in acquiring public health plans as appropriate. Works closely with local Departments of Social Services within Bassett’s service area as well as Bassett’s health plans and local Community Service organizations providing Facilitated Enrollment services.
• Provides complete Insurance Support Services to front end processes as well as to Bassett patients
• Determine eligibility status of assigned patients scheduled as self-pay within 5 business days of DOS
• Refer true self-pay patients to appropriate clinic staff as well as CSP program
• As appropriate determine self-pay patients' eligibility for other public insurance programs
• Provide presumptive eligibility and application assistance for appropriate patients as needed
• Verifies Medicaid status of selected Medicaid patients within 5 business days of DOS vides verification and eligibility status on "high ticket" outpatient procedures as assigned
• Work closing with CSP program, develops process to reduce MedSpar recalls from front end work
• Work closely with billing office to identify front end denial trends and develops intervention actions
• Provides coordination with the patient, insurance company, and hospital on the complete pre-certification process, which includes second opinions and tertiary referrals
• Process additional information requests and coordinate with the insurance biller on requests for letters of medical necessity from and to insurance companies
• Review patient chemotherapy protocols and determine insurance benefits and patient responsibility
• Assist with SSI or SSD
• Assist and/or process STD (short term disability) forms
• Assist with payment arrangements for patients with outstanding patient balances
• Assist fund management
• Assist patients with treatment cost analysis
• Educate patients about financial resources
• Assist with obtaining or understanding insurances
• Information Management
• Develop working knowledge of Bassett payer system and financial classifications
• Assist system administrators in providing coaching for end users on system data entry
• Maintain department specific data bases and data management processes
• Performs other duties as requested and observed by supervisor or manager

Qualifications

• Education: 2 Year/Associate Degree in health related field, preferred
• Experience: Preferred minimum 3 years of work-related experience:
• in healthcare, eligibility/verification processes and systems working with uninsured and Medicaid patients knowledge of NYS presumptive eligibility/facilitated enrollment processes knowledge of public health insurance programs and other community resources available to the disadvantaged experience working with diverse groups of individuals from a variety of cultural, socioeconomic and educational backgrounds
• Experience in one-to-one counseling and coaching, preferred
• Skills: Accountability
• Advocacy
• Attention to Detail
• Communication
• Community Relations
• Computer Skills
• Networking
• Responsibility
• Time Management
• Physical Requirements: Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking or standing are required only occasionally, and all other sedentary criteria are met
• Occasional grasping, lifting, pulling, pushing, reaching, standing
• Frequent typing/clerical/dexterity, hearing, repetitive motion, seeing/monitor/computer use, talking, visual acuity (color, depth, perception), walking
• Travel: No travel required