SUMMARY OF POSITION:
The Financial Coordinator will verify eligibility and benefits for patients as well as obtain required pre-certifications and/or verify medical necessity is met. If a patient from Provision CARES Proton Therapy Nashville is sent to an outside facility for other services and those services do not supply authorization services, we will obtain authorization for these services as well. Our team will call all new patients as they are put on the schedule to review their insurance benefits and coverage. The team will meet again with the patients at consult and once services are scheduled to begin to complete required documents and collect as much as possible of the patient’s estimated out of pocket responsibility. The goal of Financial Coordinator is to help keep patients informed throughout the insurance process, keep down claim denials for more timely collections, as well as collecting the patient’s portion for services rendered to help minimize the need for patient statements.
- Verify insurance eligibility & benefits in full detail
- Prepare patient folders for consult which will include a clear explanation of insurance coverage and patient benefits.
- Meet with patients both at consults and at pre-treatment appointments, as well as if the patient requests a meeting with the finance team.
- Calculate the patient’s cost for services rendered and collect this at the time of pre-treatment services or set up applicable payment plan.
- Work with insurance carriers to obtain needed authorizations for treatment.
- Prepare Letters of Medical Necessity for initial submission when requesting treatment.
- Schedule peer to peer reviews and prepare personalized appeal letters and packets.
- Keep the patient updated throughout the entire process.
- Arrange treatment agreements outside of insurance carriers by working alongside employers with self-funded plans.
- Work with patients to set up payment agreements for those who decide to pay for treatment on their own.
- Assist patients in preparing their own insurance appeals as needed.
- Take part in patient complaint calls with carriers.
- Assist patients, who qualify, with the financial assistance process. Collecting needed application and supporting documents. Organize & submit complete file to reviewing committee. Inform patient of outcome once process is complete.
- Communicate within the clinic to keep the staff informed as their patients begin the financial process. Clear patients for treatment or withdraw their case as needed.
- Ensure the patient authorizations will remain effective throughout the entire treatment period.
- Effectively and efficiently document each process into the required system(s).
- Assist the Patient Services Manager with patient appeal letters and patient advocacy
- Assist the Billing Department when needed, if claims are denied
- High school diploma required, Associates or Bachelor’s Degree preferred
- Minimum of 2 years of experience working with insurance is required
- Pre-certification experience is preferred
- Must have a strong understanding of insurance benefits, policies and regulations, as well as how a policy pays and how to calculate what a patient will owe for services rendered
- Proficient computer skills with experience working in an EHR is required
- Ability to Multi-task
- Excellent attention to detail
- Strong verbal and written communication skills is necessary
- The normal schedule for this position is either 8:00am-4:30pm or 8:30am-5:00pm
- May be required to stay late or come in early at times