Lead Financial Navigator WCI

Be inspired. Be valued. Belong.

At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorship and leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Familyfocused benefits
• Wellness incentives

Ongoing mentorship development leadership more!

The Lead Financial Navigator position supports The Emory Clinic outpatient and Patient Financial Services operations with overall care coordination for patients serving as their primary point of contact for all customer service administrative and scheduling needs. They act as the liaison for the patient and family working with both administrative and clinical staff from multiple departments to improve the patients overall experience with Emory Healthcare. Position enhances the patient experience by serving as the primary point of contact and administrative care coordinator for established patients and/or family members. They ensure that all related patient appointments for an episode of care are secured in a timely manner and coordinated for patient convenience and address and resolve process or administrative issues impeding timely access to care.

• Monitors inhouse accounts to improve revenue and timely payment of claims.
• Performs cost estimates and follow guidelines associated with prepayment process.
• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Emory Healthcare.
• Lead Financial Navigator position must have knowledge of all aspects of Emory Healthcare processes from registration to billing.
• Responsible for financially clearing patients prior to their visits by collecting payment or determining insurance eligibility.
• Acts as a liaison between PFS and clinic operations to resolve customer inquiries related to billing and customer satisfaction in a timely matter.
• Complete cost estimates and follow guidelines associated with prepayment process.
• Responsible for training new staff members serves as department resource in absence of Supervisor.
• Performs all aspects of benefits verification.
• Provide financial assistance for satellite clinics for assigned sections when required.
• Requires knowledge of Medicare Medicaid and ThirdParty carriers.
• Maintain a knowledge base of patient financial assistance and copay programs available.
• Ability to solve problems independently and must be strongly vested in team management.
• Responsible for collaborating with physicians and members of the care delivery team to triage coordinate and consistently manage the patient care financial experience.
• Position works with patients and families to answer questions provide emotional support and resolve issues concerning the administrative coordination of their care.
• Reviews patients insurances and serves as the primary point of care for these patients and their families.
• Perform other duties as assigned or requested.
• The Lead Financial Navigator position must have knowledge of all aspects of Emory Healthcare processes from registration to billing.
• The Lead Financial Navigator will be responsible for interacting with section staff patients and Financial Navigators to assure team efforts in the care and handling of all patients that need financial Resources assistance account inquiry Medication assistances and any other oncology financial needs.
• Responsible for financially clearing patients prior to their visits by determining insurance eligibility or seeking financial assistance.
• Acts as a liaison between Financial navigators and clinic operations to resolve customer inquiries related to billing and customer satisfaction in a timely matter.
• Responsible for training new staff members and performing monthly assessment for Financial Navigators
  • 1. The Lead Financial Navigators will serve as a central resource for the section faculty and staff and outside departments in the education of financial oncology and insurance requirements that may impact the specialties clinical practice processes and monetary viability.
  • Provide back up for other sections and coverage for satellite Oncology clinics for assigned when required.
  • Collaborate with Social Workers and Clinical staff regarding patient financial resources when required.
  • Perform all aspects of benefits verification.
  • Requires knowledge of Medicare Medicaid and ThirdParty carriers and referrals and precertification procedures.
  • Employee may be responsible for other duties as assigned.
  • Participates in professional activities and organizations to maintain knowledge of current trends practices and developments.
• This Lead Financial Navigator role includes but not limited to;
  • guidance and support to patients regarding their financial obligations insurance coverage and available assistance programs. This involves explaining billing processes insurance policies and helping patients understand their financial responsibilities.
  • the accurate and timely submission of claims to insurance companies including resolving any claim denials or discrepancies. Collaborating with billing specialists to ensure compliance with billing regulations and maximize reimbursement.
  • patients in applying for financial assistance programs such as Medicaid Medicare or Emory Healthcare hospital charity programs. Evaluating patients eligibility for assistance based on income assets and other criteria.
  • as an advocate for patients in navigating the complex healthcare billing and insurance system. Addressing patient concerns and resolving disputes related to billing or insurance coverage.
  • financial counseling sessions with patients to help them understand their healthcare expenses payment options and financial responsibilities. Providing education on budgeting debt management and financial planning as needed.
  • with clinical staff case managers and other departments to ensure seamless coordination of financial and clinical aspects of patient care. This may involve participating in interdisciplinary team meetings and communicating relevant financial information.
  • to healthcare regulations billing guidelines and privacy laws such as HIPAA (Health Insurance Portability and Accountability Act). Staying updated on changes in healthcare policies and regulations that may impact financial processes.
  • accurate records of financial assistance applications insurance verifications billing activities and patient interactions. Generating reports on financial assistance utilization reimbursement trends and other key metrics for management review.
  • prepares and analyzes various internal and external financial reports and governmental forms for errors or missing information; works with auditors to ensure accuracy of financial statements. Develops and maintains standardized managed care and various ad hoc reports as requested. Develops and maintains database to support development of managed care reports; maintains market rate and other relevant pricing information databases. Consults with department heads and assists them in implementing procedures. May train others on cost accounting and design of management reports. Provides guidance to staff on applying procedures.
• Lead Financial Navigator requires a combination of financial expertise communication skills and a commitment to assisting patients in managing their healthcare expenses effectively.
• Optimize patient coverage:
• Obtains type of coverage limitations and exclusions for insurance coverage and provides selfpay quotes to patients for oncology services.
• Works with patients to optimize access and qualification for available benefits/assistance such as Cancer State Aid Charity Care Medication Assistance and CoPay Assistance interacts with Medicare insurance companies pharmaceutical companies and assistance programs as an advocate for the patient and the clinic to ensure eligibility of coverage.
• Communicates and collaborates with the treatment team and administrative staff in supporting and maintaining understanding of the financial implications of medical intervention on the patient and healthcare provider.
• Constantly seek and maintain knowledge of new/existing avenues of financial assistance and support for patients.
• Patient Education:
• Works routinely with patients to ensure understanding and to provide support explain the financial implications of patient care and share available sources of assistance throughout their treatment such as possible copay and prescription assistance programs.
• Provides financial assistances as well as Financial Navigation to address sensitive financial issues resulting from coverage.
• Admin: Performs job related services throughout the continuum of care; primarily outpatient with a focus on newly diagnosed patients.
• Review schedules and inbasket requests for patients that have been identified needing resources.
• Provide an adequate and comprehensive financial screening for Oncology patients.
• Complete cost estimates and follow guidelines associated with making financial arrangements.
• Acts as a liaison between PFS and clinic operations to resolve financial barriers to oncology care. Performs other duties and responsibilities as assigned.
• Ensure optimal insurances coverage and payments for all oncology and financial programs services.
• Obtains details patient insurances benefit information including but not limited to outpatient prescription follow up clinic visits.
• Researches types of coverages limitations and exclusions for appropriateness according to the oncology financial program criteria.
• Discusses benefits and other financial issues with patients and or family members during initial evaluation.
• Serve as a resource for patients family members social workers coordinators Physicians and Administrative staff on patient financial matters.
• Serves as a resource to oncology patients with respects to grants foundations funding and choices of insurances coverages.
• Trains and assist oncology financial navigators with running of EPIC reports.
• Interprets and applies Centers for Medicare and Medicaid Services regulations/guidelines related to oncology financial services.
• Follow up on all accounts assigned for collections prior to during or after admissions and discharge.
• Verifies insurances as needed to resolves account balances.
• Responsible for handling and resolving incoming customer inquiries/concerns by providing patient/guarantor from physician practices with consistent and seamless experiences.
• Responsible for preparing scanning and indexing documents/ imagines being converted to electronic/digital format.
• Develop and roll out training agenda for all new hires.
• Provide supervision and staffing coverage across all financial navigator programs.
• Leads department huddles and maintains staffing grids.
• Knowledge Skills and Abilities:
• Maintains standards of professional practice strict confidentiality advocacy and ethics.
• Adheres to department and organizational policies and procedures.
• Supports the Mission Vision and Values of Emory Healthcare and Winship Cancer Institute.
• Uses effective customer service/interpersonal skills and discretion at all times and in all forms of communication with patients and with clinic staff.
• Have a high level of initiative and ability to selfdirect to solve financial problems of patients and work collaboratively with the treatment team.
• Exceptional communication conflict resolution organization followup and negotiation skills required.
• Ability to work in a highvolume caseload environment required.
• Ability to utilize software relevant to the job including Microsoft Office Suite medical records systems and medical billing systems.

MINIMUM REQUIREMENTS:

• Bachelors degree required.
• Five 5 years healthcare experience or equivalent education and experience combined.
• Some revenue cycle experience required.
• CPAR certification preferred.
• Proficient computer skills required.
• Excellent communication skills both verbal and written are required.
• Knowledge of ICD10 and CPT coding preferred.
• Occasional to frequent standing and walking Occasional sitting Close eye work (computers typing
• reading writing) Physical demands may vary depending on assigned work area and work tasks.
• Ability to provide a high level of customer service is required and ability to successfully interact with internal and external customers at all levels is required.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.