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Patient Access Specialist – Proton Therapy Center

MD Anderson

This is a Full-time position in Houston, TX posted May 29, 2021.

The mission of The University of Texas M. D. Anderson Cancer Center is to eliminate cancer in Texas , the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.

The primary purpose of the Patient Access Specialist position is to:

Coordinate financial arrangements with various payors in order to ensure maximum reimbursement for services provided. Communicate with patients, referral sources, payors and the treatment team regarding patient access and financial issues. They are responsible for coordinating all financial information and counseling matters to strengthen patients’ understanding. Manage in its entirety the referral process through MDACC’s Division of Radiation Oncology, its Satellite’s and

Proton Therapy Center . They are responsible for insurance verification and respond to insurance and patient correspondence according to procedures and clearance for all services. Communicate with patients/responsible parties concerning billing process and financial responsibilities. Provide estimated cost for treatment based upon treatment plan. We document communication with payors, patients and treatment team. Patient Access Specialist is responsible for creating a positive patient experience by accurately and efficiently handling the day to day operations relating to financial clearance activities. This includes adherence to the department’s policies and procedures related to the verification of eligibility/benefits, pre-authorization requirements, available payment options, financial counseling, new patient registration and other identified financial clearance related duties.

Key Functions

  • Assume leadership role in recommending, implementing and monitoring sound financial counseling guidelines for Radiation Oncology, and Satellite facilities
  • Interact with patients and family members (if necessary) in the most courteous, respectful and empathetic manners in discussing all aspects of their financial situation.
  • Work with other departments including XRT satellite operations and the multidisciplinary clinics (PASs) to provide patients with the most accurate estimate in an integrated and expeditious manner.
  • Strengthen the integrity and confidentiality of patient financial information by sharing that information only for reasons as stipulated by the institutional guidelines.
  • Maximize the functionality of various institution and Radiation Oncology information systems software/platforms such as ONE CONNECT and MOSAIQ to accomplish duties promptly; documenting in EPIC for all coverage and financial clearance outcomes to aid in timely claims processing.
  • Responsible for complete assurance that patients and family members (if necessary) understand all aspects of their financial relationship with the institution and the Division of Radiation Oncology.
  • Assume leadership role in managing patient data update, financial clearance status, and expeditious appointment scheduling.
  • Ensure timely, proper and efficient collection of patient demographic information and also update patients’ files regularly.
  • Following institutional and departmental guidelines, work closely with PASs, New Patient Referral, and XRT satellites to ensure expeditious triaging and scheduling of patients.
  • Responsible for ensuring that there is understanding between clinical teams, referring parties and others regarding patient appointments.
  • Asserts complete oversight in assuring verification, pre-certification and terms of various insurance plans and benefits.
  • Clearly review and manage to established institutional and departmental guidelines to achieve standards for verifying insurance, performing pre-certifications, and assuring insurance updates for all patients.
  • Establish functional and productive working relations with third-party payor agencies such as Managed Care Office and outside insurance companies.
  • Responsible for interpreting and reviewing regular contract summaries, provisions and restrictions as they apply to various patient population for Radiation Oncology, its outreach and satellite facilities.
  • Obtain and document verification of patient eligibility (and applicable effective dates) using the available institutional and/or payor systems, including real-time web portals and tools, within the applicable timeframes as outlined by department policies and procedures. Promptly notify Patient Navigator and the patient, when eligibility information is invalid and/or cannot be verified
  • Work collaboratively with Intake team to document updated and/or corrected insurance information into the system in accordance with applicable department policies and procedures
  • Obtain and document verification of patient benefits, including information regarding the product type, in-network or out-of-network status, all applicable co-payment, deductible, and co-insurance amounts or percentages, pre-existing indicator and time period, and any lifetime or annual maximums into EPIC and/or designated future state systems in a timely manner
  • Timely manage work lists for cases requiring pre-authorization and work directly with the payor or assigned third party vendor to obtain all required pre-authorizations. Seek to obtain pre-authorization through on-line web portals and tools, when available. Accurately document all reference and pre-authorization numbers, along with payor contact information, into EPIC and/or designated future state systems in a timely manner
  • For patients participating in a clinical trial, appropriately document and review with patients and the payors services being covered by the clinical trial sponsor and those designated for coverage under the patient’s insurance
  • Provides financial counseling to patients which includes reviewing cost estimates, assistance with calculating expected patient liability, discussions regarding payment requirements, collection of financial amounts dues, provide information regarding available payment plan options, and provide information regarding patient financial assistance opportunities when applicable. Financial counseling also includes reviewing ABN, MSPQ, account review and any other barriers to financial clearance with patients as needed
  • Complete and timely submit all documents (PFA, COBRA, etc,) requiring prior approval for financial clearance.
  • Promptly escalate any issues with financial clearance and/or counseling to the Financial Clearance Supervisor or seek assistance as appropriate from the Financial Clearance Center, when needed
  • Completely and accurately document conversations and communication with Patients, payors, third party vendors, MCLs and any other representative in and outside of the institution
  • Answer emails and phone calls in a timely manner and respond to voicemails and MyMDAnderson messages within the course of the business day.
  • Conducts all financial clearance activities in alignment with departmental key performance indicators to ensure that timelines are met and surpassed.
  • Assess your monthly KPIs and work to minimize variation and follow standard workflows to ensure no defects, implement self-improvement actions to be reviewed with your one up.
  • ties in a courteous and professional manner and maintains a positive working relationships with patients, physicians, payors, third party vendors and any other identified business partners
  • Seeks to improve job performance and personal growth by participating in available educational, training and mentoring opportunities
  • Perform all other duties as assigned

Working Conditions

This position requires:

Working in Office Environment

__ No

X Yes

Working in Patient Care Unit (e.g. Nursing unit; outpatient clinic)

__X No

__ Yes

Exposure to human/animal blood, body fluids, or tissues

__X No

__ Yes

Exposure to harmful chemicals

__X No

__ Yes

Exposure to radiation

__X No

__ Yes

Exposure to animals

__X No

__ Yes

Physical Demands

Indicate the time required to do each of the following physical demands:

Time Spent

Never

0%

Occasionally

1-33%

Frequently

34-66%

Continuously

67-100%

Standing

x

Walking

x

Sitting

x

Reaching

x

Lifting/Carrying

Up to 10 lbs

10lbs to 50 lbs

x

More than 50 lbs

Pushing/Pulling

Up to 10 lbs

x

10lbs to 50 lbs

More than 50 lbs

Use computer/keyboard

X

Education

Required: High school diploma or equivalent.

Experience

Required: Three years experience in healthcare, insurance or related field. With preferred degree, one year of required experience. Must pass pre-employment skills test as required and administered by Human Resources.

Preferred: Previous Radiation Oncology experience preferred.

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html

Additional Information

  • Requisition ID: 139497
  • Employment Status: Full-Time
  • Employee Status: Regular
  • FLSA: non-exempt, eligible for overtime, and is subject to the provisions of the Fair Labor Standards Act (FLSA)
  • Work Week: Days
  • Fund Type: Hard
  • Pivotal Position: No
  • Minimum Salary: US Dollar (USD) 34,000
  • Midpoint Salary: US Dollar (USD) 43,500
  • Maximum Salary : US Dollar (USD) 53,000
  • Science Jobs: No
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