Utilizes clinical judgment and insurance/financial expertise to coordinate insurance optimization and financial navigation interventions. Develops strategies to ensure cost effective, quality care outcomes to patients with complex care needs. Identifies options for insurance optimization/financial assistance individuals and families in the Cancer Health service line, focusing on strategies that will promote optimal financial health. Assesses, plans, monitors, and provides therapeutic interventions as appropriate. Collaborates with patient and family to facilitate understanding of insurance coverage, cost of care, expected out of pocket expenses, various program eligibility criteria, and navigates them over time as the patient's condition and financial needs change. Partners with patients, families, nurse navigators, social workers, financial counselors, billing and denials staff and other health care providers to ensure that the patient is supported , financial distress is lessened and that health care is uninterrupted due to financial concerns. Responds to crisis situations and engage with patients and families to access the appropriate interventions
Essential Functions
Works in close collaboration and communication with physicians and other members of the health care team in order to optimize patient's health care coverage and total financial picture, reduce distress associated with Financial Toxicity, and minimize the financial impact that the patient's plan of care has on their financial status.
Establishes and maintains positive relationships with physicians and hospital staff within hospital system, educating them about Oncology Financial Navigator services and encouraging early referral of newly diagnosed, uninsured or under-insured cancer patients. Serves as a "point person" for financial navigation throughout the cancer healthcare system.
Completes a holistic assessment of cancer patients, in person or via telecommunication, focusing on their financial needs and advocates for patient's financial needs throughout the system.
Establishes positive, supportive relationships with newly diagnosed cancer patients, using effective customer service/interpersonal skills at all times and rendering financial counseling and psychosocial interventions to address sensitive financial issues.
Partners effectively with physicians, nurse navigators, social workers, financial counselors, pharmacy and billing/denials staff.
Obtains detailed patient insurance benefit information for all aspects of the cancer treatment process. Discusses benefits and other financial issues with patients and/or family members during initial evaluation.
Establishes and maintains a database and creates reports of patient funding secured; distributes reports at regular intervals and in a timely manner. Actively monitors and gains understanding of new public and private cancer resource programs that could assist cancer patients and their families with their financial needs.
Serves as a resource for patients and their family members on financial matters. Addresses insurance coverage gaps via alternative funding options. Assists patients /representatives in the process of applying for alternative medical benefits, including those from Medicaid or other patient assistance funds.
Qualifications
Required Master's Degree Master Degree of Social Work
5 years of relevant experience relevant experience in a health care, insurance reimbursement, government programs, financial assistance resources, psychosocial assessment and interventions Required
1 year of relevant experience oncology ambulatory practice setting Preferred
CRT-Fellow of the Healthcare Financial Management Association (FHFMA) - HFMA Healthcare Financial Management Association preferred Or
CRT-Healthcare Financial Professional, Certified (CHFP) - HFMA Healthcare Financial Management Association preferred Or
CRT-Inpatient Coding Auditor, Certified (CICA) - HFMA Healthcare Financial Management Association preferred Or
CRT-Revenue Cycle Representative, Certified (CRCR) - HFMA Healthcare Financial Management Association preferred Or
CRT-Specialist Accounting & Finance, Certified (CSAF) - HFMA Healthcare Financial Management Association preferred Or
CRT-Specialist Business Intelligence, Certified (CSBI) - HFMA Healthcare Financial Management Association preferred Or
CRT-Specialist Managed Care, Certified (CSMC) - HFMA Healthcare Financial Management Association preferred Or
CRT-Specialist Physician Practice Management, Certified (CSPPM) - HFMA Healthcare Financial Management Association preferred
Primary LocationSITE - Lemmen-Holton Cancer Pavilion - 145 Michigan St - Grand Rapids
Department NameAdministration - Cancer Health - GR
Employment TypeFull time
ShiftDay (United States of America)
Weekly Scheduled Hours40
Hours of Work8:00 a.m. - 4:30 p.m.
Days WorkedMonday - Friday
Weekend FrequencyN/A
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