Patient Financial Advocate- infusion

The Patient Financial Advocate and Prior Authorization Coordination

• Receive and review infusion referrals to ensure completeness and understanding of specific patient needs.
• Contact patients to assist with insurance paperwork and infusion start-up forms.
• Perform comprehensive benefits investigations for every patient, including verifying coverage, determining financial responsibility, and discussing costs with the patient before scheduling.
• Collaborate with the PFS, PA, and Infusion teams to ensure coverage and authorization are in place prior to appointments.
• Confirm co-pay assistance, payer, or manufacturer requirements, and MCN account status prior to infusion.
• Apply for and manage financial assistance programs including:

* Grants: Identify eligible patients, apply for funding, track available funds, and maintain renewals.

* Patient Assistance Programs: Determine financial need, complete applications, monitor renewals, and liaise with foundations.

* Co-pay Programs: Identify eligible patients and ensure enrollment for those who qualify.

* Free Drug Programs: Track all enrolled patients, maintain spreadsheets, order and confirm receipt of free drug shipments, coordinate with foundations, and manage retroactive coverage when applicable.

• Monitor insurance accumulations (such as out-of-pocket maximums) and transition patients from free drug programs to billable status when thresholds are met.
• Ensure start forms are current, accurate, and submitted electronically, when possible, for all infusion medications.
• Serve as a resource and expert problem solver for internal teams and external partners, assisting with insurance, authorization, and patient financial issues.

Administrative and Financial Operations Support

• Perform administrative and financial tasks to support Infusion Center operations, ensuring an efficient experience for both patients and staff.
• Research and maintain knowledge of drug supplier resources, government grants, charitable foundations, and co-pay assistance programs. Communicate new or updated program information to the Infusion Center Manager, PFS Manager, and other stakeholders.
• Monitor communication channels including in-baskets and fax folders for insurance issues, prior authorization updates, co-pay and referral forms, and other relevant documents.
• Collaborate with Infusion, Scheduling, and Billing teams to resolve discrepancies, billing concerns, and payer-related denials.
• Work closely with professional staff to share information, educate team members, and address patient concerns.
• Participate in process improvement initiatives by identifying workflow efficiencies and assisting in the implementation of new procedures that enhance patient access and experience.
• Manage and reconcile infusion visit tracking reports to ensure accurate and timely billing of all services.

Other Duties as Assigned

* Assist with general departmental initiatives and projects as directed by leadership.

* Support quality improvement activities and contribute to a culture of compassionate, patient-centered care.

* Provide backup support for colleagues during absences or high-volume periods.

Education and Experience:

• High School graduate or GED equivalent required. Bachelor's degree in health-related field highly desired.
• At least two years of previous medical office experience, preferably in the areas of revenue cycle or financial counseling.
• Previous experience with infusion services highly desired.

Knowledge, Skills, and Abilities:

• Strong knowledge of health insurance and its impact on billing. Knowledge of prior authorization process.
• Patient centered, strong customer service orientation. Excellent communication and interpersonal skills.
• Ability to be organized, work independently, exhibit mature judgment, and make sound decisions.
• Accurate and precise reading and writing skills. Strong command of the English language; good spelling/grammar.
• Knowledge of medical terminology and ICD-10/CPT coding.
• Ability to handle confidential information with the utmost judgment and discretion.
• Proficiency with MS Office, including Word, Excel, and Outlook. Proficiency with electronic health record.

III. Working Conditions:

Environment:

• Normal office environment.

Physical Demands:

• Requires long periods of sitting and working at computer terminal.

Equipment Used:

• Standard office equipment, including personal computer, telephone, and related technology.