Financial Advocate

St. Charles Health System Inc.; Bend (OR); Hybride; USD 31 000 - 41 000; Plein temps

Résumé du poste

St. Charles Health System Inc. is seeking a Cancer Center Financial Advocate in Bend, OR. This role focuses on insurance verification, cost estimation, and prior authorizations to ensure timely access to cancer care.

The position requires strong communication, patient service orientation, and experience with payer processes. The role supports the Cancer Center in coordinating financial aspects and reducing delays in treatment.

Qualifications

• Requires high school diploma or GED.
• Experience in healthcare billing/insurance preferred.
• Knowledge of payer policies and cost estimation helpful.

Responsabilités

• Verify patient insurance eligibility and coverage.
• Determine cost-sharing (co-pays, deductibles, co-insurance).
• Maintain knowledge of Medicare/Medicaid/Commercial plans.
• Provide accurate cost estimates for Cancer Center services.

Connaissances

Insurance verification

Authorization processes

Analytical Skills

Communication

Customer service

Formation

High school diploma or GED

Two years college or technical degree

Outils

Mosaiq

Aria

Epic

Description du poste

Job Title & Pay

Pay range: $22.30 - $30.11 hourly, varies on experience. Medical Oncology - Remote/Hybrid Bend, Oregon. Relief Differential: 15% ST.

Job Description Title

Cancer Center Financial Advocate

Reports To

Operations Manager

Department

Cancer Center

Schedule & Employment

Schedule Weekly Hours: 0 Caregiver Type: Relief Shift: First Shift (United States of America). Is Exempt Position? No Job Family: INSURANCE COLLECTOR. Scheduled Days of the Week: Monday-Friday Shift Start & End Time: 0800-4:30.

Responsibilities

• Verifies patient insurance eligibility and coverage.
• Determines co-pay, deductible, co-insurance, and maximum out-of-pocket amounts in accordance with St. Charles Health System credit and collection guidelines.
• Maintains advanced working knowledge of Medicare, Medicaid, Commercial, Managed Care, and HMO plans.
• Stays current on payer policies, authorization requirements, and regulatory changes.
• Provides accurate, timely cost estimates for Cancer Center services using available estimation tools and payer-specific benefits.
• Obtains and coordinates prior authorizations and referrals for all services ordered by Cancer Center providers, ensuring compliance and minimizing delays in care.
• Track authorization expirations, regimen changes, surgical scheduling timelines, and progression to prevent treatment delays.
• Identify and resolve insurance barriers that impact reimbursement eligibility for infusion, radiation, and surgical oncology services.
• Coordinate peer-to-peer review support with providers when required.
• Maintains awareness and application of CPT and ICD-10 coding relevant to oncology services to support authorization and billing processes.
• Interpret NCCN-guided treatment pathways and payer oncology policies to ensure alignment with medical necessity requirements.
• Identifies and assists eligible patients with internal and external financial assistance programs, including but not limited to: Free drug and replacement drug programs and Manufacturer assistance programs.
• Collaborates with pharmacy and clinical staff to receive, document, log, and maintain inventory of medications obtained through assistance programs in accordance with compliance standards.
• Refers patients to St. Charles Health System Financial Assistance Program and ensures timely distribution and completion of applications.
• Assists with review, tracking, follow-up, and resolution of denied claims related to authorization or coverage issues.
• Demonstrates strong analytical and problem-solving skills, including accurate calculation of financial responsibility.
• Supports the organization’s vision, mission, and values in all activities.
• Actively participates in Lean initiatives and continuous improvement efforts.
• Maintains a safe environment for patients, caregivers, and visitors.
• Conducts all activities with the highest standards of professionalism and confidentiality.
• Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• Delivers excellent customer service with professionalism, compassion, accuracy, and timeliness.
• May perform additional duties of similar complexity within the organization, as required or assigned.

Education

• Required: High school diploma or GED.
• Preferred: Two years of college or technical degree.

Licensure / Certification

• Required: N/A
• Preferred: Certified Healthcare Financial Professional (CHFP) or similar certification. Oncology or revenue cycle-related certifications.

Experience

• Required: Minimum one (1) year of experience in healthcare, hospital, clinic or medical insurance billing office.
• Preferred: Two (2) or more years of experience in hospital, oncology, clinic, or medical billing environment.
• Experience with: Oncology EMR systems (e.g., Mosaiq, Aria, Epic), Insurance verification and authorization processes.

Personal Protective Equipment

Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.

Additional Position Information

Must have excellent communication skills and ability to interact with a diverse population and professionally represent St. Charles Health System. Ability to effectively interact and communicate with all levels within St. Charles Health System and external customers/clients/potential employees. Strong team working and collaborative skills. Ability to work under pressure in a fast-paced environment. Ability to multi-task and work independently.

Physical Requirements

• Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level.
• Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation.
• Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing.
• Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle.
• Never (5%): Climbing ladder/step-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level.
• Exposure to Elemental Factors Never (5%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category Low Risk for Exposure to BBP.

Employer Overview

St. Charles Health System is a private, nonprofit organization, dedicated to providing high-quality care and the latest in health care technology to the communities it serves. Headquartered in Bend, Ore., St. Charles is an integrated delivery system, with a strong focus on population health, that provides a full range of evidence-based health care services within a 32,000-square-mile area in Central and Eastern Oregon. The health system owns and operates a trauma level II, tertiary referral center in Bend, a trauma level III, type B rural hospital in Redmond, and trauma level IV critical access hospitals in both Prineville and Madras. As the largest employer in Central Oregon, St. Charles Health System and St. Charles Medical Group care for our communities in more than two dozen outpatient clinics and in more than 20 specialty areas of medicine.