Job Description
Why ThedaCare? Living A Life Inspired!
Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.
At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you're interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.
Benefits, with a whole-person approach to wellness -
- Lifestyle Engagement
- e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support
- Access & Affordability
- e.g. minimal or zero copays, team member cost sharing premiums, daycare
About ThedaCare!
Summary : 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: KEY ACCOUNTABILITIES:
1. 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.
2. Performs pre-authorizations for services per insurance requirements. Understands services provided while utilizing NCCN guidelines to ensure accurate and timely claim submission.
3. 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.
4. Serves as subject matter expert to providers and others regarding documentation requirements for accurate charge capture.
5. 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.
6. Contacts and/or meets with patients to discuss pre-authorization outcomes, billing questions, denials, or concerns. Refers patients to patient accounting as appropriate.
7. Supports patients in obtaining foundation/grant money to aid in medication coverage or refers them to other financial support services when need is identified.
QUALIFICATIONS:
•High school diploma or GED
PHYSICAL DEMANDS:
•Ability to move freely (standing, stooping, walking, bending, pushing, and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
•Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties
WORK ENVIRONMENT:
•Climate controlled office setting with daily movement throughout the campus
•Interaction with department members and other healthcare providers
•Frequent sitting with movement throughout office space •Use of computers throughout the work day
•Frequent use of keyboard with repetitive motion of hands, wrists, and fingers
Scheduled Weekly Hours: 40
Scheduled FTE: 1
Location: ThedaCare Regional Cancer Center - Appleton,Wisconsin
Overtime Exempt: No ThedaCare
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