Patient Advocate | Oncology Services

Avera St Marys Hospital

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$20.50 $27.00

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible to provide assistance to patients and/or families as they navigate through all aspects of their medical paperwork including insurance billing payment and collection process. This position is responsible to screen patients to determine potential for program assistance complete application with patient and families and follow up after discharge regarding application and maintain knowledge base of community agencies and resource to facilitate appropriate referrals including maintaining a thorough understanding of eligibility requirements and current laws governing government programs. A successful advocate will communicate with patients families case managers and providers to assess care plans and corresponding coverage needs and work in a compassionate and tactful manner to help facilitate access to and provide continuity of care. Advocates also work with other members of the care teams insurers financial and administrative personnel.

What you will do

• Insurance Screening: Obtain detailed patient insurance benefit information for all aspects of cancer care including but not limited to outpatient services and prescription drugs. Verify insurance coverage and other medical benefits and acquire necessary referrals and authorizations.
• Identify selfpay patients and evaluate coverage opportunities. Assist with completion of all needed applications for coverage including applications for drug assistance. Provide accurate cost estimate details to patients prior to appointments.
• Discuss benefits and other financial concerns with patients and/or family members during initial referral and during continuation of care. Identify and effectively communicate financial information to team members patients and their families with emphasis on identifying any potential patient outofpocket liability. Assist patients with questions concerning insurance coverage and other financial issues. Document in patient record as appropriate.
• Obtain all necessary insurance authorizations. Obtain clinical information as needed from the medical record to answer clinical questions during authorization process. Communicate with care team and pharmacy staff to ensure that all treatments meet medical necessity. Draft medical necessity authorization request letters to include insurance contact information patient history and appropriate scientific literature. Manage both routine and complex insurance authorizations directly. Responsible for the coordination of level II appeals with oversight from the appropriate medical staff.
• Work with patients their families and team members to help address insurance coverage gaps via alternative funding options including but not limited to help with completing applications for copay assistance compassionate use drug and/or Avera Patient Assistance. Assist patient and family members in completing workrelated documentation including but not limited to FMLA short term disability long term disability and work letters.
• Maintain tracking mechanisms for status of authorization requests referrals and drug assistance. Regularly assesses updated information regarding insurance data authorizations and preferred providers. Track free drug assistance to ensure patients maintain coverage when initial enrollment ends.
• Facilitate resolution of patient billing issues which may include appealing denied claims. . Work in collaboration with the patient insurance and business office.
• Work as a member of a team of Patient Advocates to assist in other oncology departments as needed. Work with multiple disciplines and departments to ensure clear communication and prompt delivery of treatment. Accurately document all interactions related to advocacy within the EMR.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others hear understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge skills and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions as long as the accommodations do not cause undue hardship to the employer.

Required Education License/Certification or Work Experience:

• Associates social work coding or a healthcarerelated field and/or combination of experience and education.
• 13 years Experience in healthcare and insurance verification.

Expectations and Standards

• Commitment to the daily application of Averas mission vision core values and social principles to serve patients their families and our community.
• Promote Averas values of compassion hospitality and stewardship.
• Uphold Averas standards of Communication Attitude Responsiveness and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles laws regulations and standards associated with but not limited to CMS The Joint Commission DHHS and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying parttime and fulltime employees. We support you with opportunities to help live balanced healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Free health insurance options for fulltime single coverage on Avera High Deductible Health Plan

• Up to 5% employer matching contribution for retirement

• Career development guided by handson training and mentorship

Avera is an Equal Opportunity Employer Qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability Veteran Status or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application please callor send an email to .