Financial Counselor

Oncology Financial Counselor  

Job Summary 

The Oncology Financial Counselor supports patients during this challenging time, helping to reduce the financial burden throughout the continuum of their care.  The Oncology Financial Counselor helps evaluate insurance benefits and discuss with patients their responsibility and programs available to assist with high co-pays or out of pocket amounts.  The Oncology Financial Counselor obtains all authorizations for treatment and ensures criteria have been met and is accurate. They will help patients understand insurance benefits and obligations and assist patients with completing important paperwork for assistance programs if applicable.  The Oncology Financial Counselor also coordinates with the business office in assisting with resolving claim issues and denials. 

Essential Job Functions 

• Plan, schedule, and maintain processes and performance to accomplish duties within time frames. 

• Processes all Chemotherapy and Infusion Treatment Authorizations 

• Works fax que daily for new orders that require authorizations 

• Ensures all orders are valid with name, DOB, physician signature, ICD-10 code 

• Ensure all orders meet medical necessity  

• Appeal letters as needed for denials 

• Works closely with Patient Financial Services to review any claim of denials that have been authorized. 

• Provides the necessary patient information required to support claim process and denials.  

• Manage all specialty pharmacy scripts that require authorization 

• Work with specialty pharmacy for setting up new scripts  

• Fax scripts to specialty pharmacy for refills 

• Works with patients on copay and out of pocket cost for specialty drugs  

• Initiating mail order pharmacy enrollment 

• Patient Assistance Programs 

• Copay assistance 

• Drug replacement programs 

• Research available patient assistance programs 

• Obtain patient financial information to support assistance programs 

• Follow each patient on assistance programs and resubmit applications annually 

• Contribute to and promote positive relationships between physicians, hospital staff, guests and the local community. 

• Respects at all times the confidentiality of patient information. Ensure compliance with confidentiality standards. 

• Promotes a positive relationship between staff, physicians, patients, and guests. 

• Meets with other hospital personnel, physicians, or patients to facilitate cooperation and resolve existing or potential conflicts.  Handles conflict with tact and courtesy. 

• Communicates effectively with patients in regard to financial information for treatment. 

• Follow up on issues or complaints.  Resolves problems that may occur in the financial counseling area in a timely manner.   

• Participates in various hospital and community events. 

• Participates in the planning, development and implementation of annual department goals and objectives 

• Reviews department’s goals annually, providing input and assists in the development of personal and team goals and objectives to support the plan. 

• Adheres to Corporate Compliance Program
• Responsible for maintaining and protecting the confidentiality of all Protected Health Information.  

• All other duties as assigned.  

Education