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Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.



LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.



Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Summary

The Oncology Financial Navigator is responsible for global patient financial support to any patient receiving services in the Cancer Institute. The overall goal is to improve the patient experience by alleviating the financial toxicity with a focus on our uninsured and underinsured patient population. This is done by reducing the burden of out of pocket responsibilities by facilitating patient enrollment in internal and external assistance programs. This is done while simultaneously protecting the hospital revenue by obtaining maximum reimbursement for our high dollar treatments.Job Duties

  • Review of Infusion center Patient Schedules (DAR) to ensure optimal insurance coverage to ensure account collectability. o Medical necessity (standard of care review) o Obtain proper authorization o Performs Benefit and eligibility verification for all new patients/new insurances. These functions includes having and maintaining proper system access to insurance vendors to ensure up to date information of authorization and medical necessity requirements.
  • Expert on external resources such as Pharmaceutical Drug Replacement programs (IV & Oral medication), copay relief programs, PATH (Medicaid) and APPRISE (advice on Medicare supplemental programs)
  • Expert on internal resources such as pharmacy charity cards. Patient Financial Assistance Program (FAP) and Cancer program funds
  • Facilitates off-label process for non-covered services (ABN waiver process) including estimating charges, researching available assistance programs and estimating remaining out of pocket costs
  • Collaborates with Patient Financial Services dept. (PFS) to resolve issues pertaining to authorization and medical necessity denials to obtain maximum hospital reimbursement.
  • Able to adapt to constantly changing situations such as add-on treatments multiple treatment regimen changes and modalities (radiation, chemotherapy and surgery). Problem solving skills as financial implications may influence the patient treatment plan and treatment approach and ability to respond to financial inquiries regarding cost of services.
  • Works in coordination with the clinical team to ensure coverage of services to achieve the best outcome for the patient.
  • Provides proactive financial advice from beginning of treatment at key entry points such Breast Health Services & Multidisciplinary clinics. Services are continued through treatment selection and the remainder of the cancer journey
  • Track all monthly activity for reporting to Oncology leadership
  • Maintains current and detailed knowledge of all third-party payer requirements and changes as well as posted policy updates and regulatory standards.
Minimum Qualifications
  • Bachelor’s Degree in related healthcare field or
  • 3 years In a healthcare setting in Oncology,coding, billing, registration, insurance verification/authorization.
  • • Ability to anticipate and understand customer financial needs and work through complex treatments scenarios
  • • Communicate patient needs to appropriate personal
  • • Demonstrate expert knowledge in determining 3rd party insurance medical benefits and billing requirements
  • • Must be able to maintain confidentiality and have an understanding of patient’s rights
  • • Must understand oncology-specific treatments and related insurance coverage issues, including rules governing medical necessity
  • • Must possess the ability to combine compassion with strong professional skills
  • • Completion of ACCC Financial Advocacy Boot Camp (Level I & II) within 90 days of employment
  • Proficient in medical terminology, word processing & spreadsheet software as well as schedule/billing systems.
  • Knowledge of PC operations.
Physical Demands

Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.



Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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