Employment Type:
Full time
Shift:
Day Shift
Description:
Trinity Health System Southeast Michigan, one of the nation's top health care services providers, spanning five counties in Southeastern Michigan. SJMHS represents more than 2,700 physicians and 14,000 nurses and staff, and includes 6 Hospitals, 5 Outpatient Health Centers, 8 Urgent Care Facilities and over 25 Specialty Centers.
Candidates with Medical Billing, Insurance Verification, Medical Terminology, Experience with Approvals, Denials and strong EMR skills are encouraged to apply. CHONC Certification is preferred but not required.
Trinty Health System is one of Michigan's most advanced cancer providers. We use cutting edge treatment technology, provide the latest clinical research trials, offer classes, events and support groups as well as other cancer support services, and our multidisciplinary team approach provides the highest quality patient outcomes which shows in our accreditations and recognitions.
POSITION PURPOSE
Under limited supervision, assesses financial needs of new and established oncology patients based on specified treatment protocols. Determines liability on patient accounts, works with patients or their representatives to provide financial assistance, and facilitates processing of Medicaid and other financial assistance applications. Provides patient and health care team education and links to resources. Also responsible for data collection, initiating eligibility determination for the Health System's charity care fund, and resolution of accounts receivables.
Essential Functions
Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission,
Values, Vision, Actions & Promise in behaviors, practices & decisions.
Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads
through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.
Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.
Maintains a working knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure
adherence in a manner that reflects safe, honest, ethical & professional behavior & safe work practices.
Functional Role (not inclusive of titles or advancement career progression Provides patient counseling regarding treatment costs, insurance coverage, available payment resources, and financial assistance options. Secures and documents payment arrangements. Submits authorization for initial and subsequent high-cost infusion and oncology services based on complex treatment plans. Coordinates with the patient, physician, insurance company, and pharmaceutical company to complete the required pre-authorization process. Validates payable diagnosis codes/medical necessity and prior therapy requirements according to FDA and NCCN guidelines. Assists patients in financing, payment plans, financial assistance and all financial options through the organization. This includes grants, co-pay assistance for high-cost pharmacy/drugs and free-drugs for infusion and specialty care patients. Monitors assigned patient accounts through entire revenue cycle to ensure copay program claims, payments, denials, and other assistance programs are being processed properly. Assists with ordering, tracking, and reporting of all free drugs obtained. Collaborates with the treatment team on the financial implications of medical intervention to the patient and the health care provider. Responsible for case management of complex financial clearance needs for patients and elevates cases as appropriate. Works closely with RSO and division leadership to improve collections.
Minimum Qualifications
High school diploma or GED.
Minimum two (2) to three (3) years experience working in Patient Access or Patient Accounting for hospital
registration and / or hospital reimbursement services
Obtain National certification in HFMA CRCR and/or NAHAM CHAA required within one (1) year of hire.
Understanding of basic billing and coding.
Additional Qualifications (nice to have)
Bachelor's degree or advanced certification or a combination of advanced training and/or certification (e.g.,
Registered Nurse, Licensed Practical Nurse, Certified Pharmacy Technician,
Registered Health Information Technician, or medical coding certification through AHIMA or AAPC
Epic experience preferred.
Knowledge of federal or state government agencies including but not limited to Medicare, Medicaid, VA or Charity
Care programs, or patient management and healthcare accounts receivable within the healthcare revenue cycle.
Physical & Mental Requirements & Working Conditions
Direct Healthcare Services / Indirect Healthcare / Support Services:
Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional
Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional
Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional
Exposure to interruptions, shifting priorities & stressful situations. Frequent
Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous
Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some
background noise. Continuous
Perform manual dexterity activities & / or grasping / handling. Frequent
Ability to climb, kneel, crouch & / or operate foot controls. Occasional
Use a computer / other technology. Continuous
Sit with the ability to vary / adjust physical position or activity. Continuous
Maintain a safe working environment & use available personal protective equipment (PPE). Frequent
Comply with Trinity Health's Code of Conduct, policies, procedures & guidelines. Continuous
Ability to provide assistance in the event of an emergency. Occasional
Direct Healthcare Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity.
Occasional
Lift a maximum of 30 pounds unassisted. Occasional
Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Frequent
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional
Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional
Indirect Healthcare / Support Services:
Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional
Lift a maximum of 30 pounds unassisted. Occasional
Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional
Encounter a clinical / patient facing / hands on interactive work environment. Frequent
Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous
Work outdoors with variable external environmental conditions. Occasional
Employees of Trinity Health System enjoy…
Visit www.trinityhealth.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Joseph Mercy Health System.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.