Financial Counselor-Revenue Navigator

The Revenue Navigator or Financial Counselor will create an environment where knowledge and information regarding patient services being rendered, approved and charged is communicated effectively at the client level in order to maximize reimbursements. Excellent communication skills are required to interact with clients, patients, and internal partners on a daily basis.

Essential Functions

• Obtain referral, precertification and/or authorization for Radiation Oncology services within 48 hours of notification to positively impact DSO for 100% of patients that require authorization.
• Handle patient registration with demographic entry and insurance verification to include network and payor participation; prior to patient visit to positively impact DSO. Nashville billing staff should spend 5% of their time verifying and updating patient demographic or insurance information for billing.
• Weekly attendance at clinical chart rounds as liaison between Radiation Oncology department and Billing Department for both RBS and the hospital.
• Notify Billing Departments of any special instructions, for example, Skilled Nursing Facility or Inpatients. Demonstrated by <3% error rate on voids and/or rebills for this reason.
• Obtain knowledge of industry standards for Radiation Oncology and utilize coding research tools to provide training to team members and clients. Required attendance at one coding conference/webinar/seminar annually.
• Minimize physician peer to peer reviews to less than one per week.
• Successful patient engagement and financial counseling standards, to be demonstrated by measuring number of patient contacts. Must meet or exceed 80% of patients on treatment.
• Understand and implement necessary processes to obtain authorization for services within 48 hours of notification of scheduled patient. Must meet on 100% of patients that require authorization.
• Monitor LCDs and insurance policy specific requirements for Radiation Therapy. Communicate all findings in a quarterly report to Billing Department Staff.
• Review and ensure that all charges documented are captured correctly against industry standards with special consideration of CCI edits, MUE limits, and diagnosis code requirements. Error rate should be 3%.
• Excellent verbal and written communication to clients, patients and peers.
• Customer service focused for both patient and clients; empathetic toward patient needs.

Physical Demands

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to lift/carry up to 25 pounds. Ability to sit/stand for long periods of time. Good manual dexterity with the ability to perform repetitive hand/wrist motions. Ability to manage multiple tasks as assigned and handle stressful situations. May require travel at times to either client sites or RBS office locations. Requires mastery of complex language, comprehension, reasoning, and analytical skills typically found in mid to high-level work. May require travel at times to either client sites or RBS office locations based on client needs.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

• High School Diploma
• Minimum 5-years experience with Medical Billing and Patient Accounts
• Minimum 5 years of Radiation Oncology billing/coding experience preferred
• Clinical office experience preferred

Key Skills and Abilities

• Excellent verbal and written communication
• Problem Solving
• Customer service focused
• Relationship building
• Self-motivated
• Strong organization skills
• Ability to handle sensitive patient information with confidentiality