Financial Counselor

UCSF Health, AG; Burlingame (CA); Hybrid; USD 65,000 - 85,000; Full time

Job summary

UCSF Health in Burlingame and San Mateo is seeking a Financial Counselor to manage insurance coverage review, self-pay workflows, and patient assistance programs throughout oncology care. The role focuses on maximizing reimbursement and guiding patients through medical financial processes in both clinic and infusion settings.

The candidate will analyze denial trends, develop procedures, and maintain expertise on Medicare/insurance contracts, while collaborating with physicians, pharmacists, and

Qualifications

• Thorough knowledge of billing and / or collections processes, concepts, systems and external regulations.
• Knowledge of medical terminology and coding.
• Advanced knowledge of the multiple billing and accounting systems used, including coding, calculating reimbursement rates, filing appeals, conducting interviews and research, and interacting with customers, insurers, and other parties.
• Advanced analytical skills to produce comprehensive reports and identify trends and variations.
• Strong interpersonal and customer service skills to work effectively with all parties to the billing and collection process, and to productively negotiate terms for successful resolution of outstanding accounts and problems.
• Ability to communicate with patients under challenging circumstances on sensitive financial topics.
• Strong ability to provide recommendations on issues of functionality and operations in billing.
• Ability to serve as a resource, providing expertise and education to staff and management at all levels.
• Strong computer proficiency in all relevant hardware and software, with a knowledge of spreadsheet and accounting applications, and a variety of specialized billing and insurance systems.
• Knowledge of patient assistance programs that assist in minimizing the financial toxicity of cancer care and treatment.
• Solid interpersonal skills for effective information exchange and problem solving with all levels of management and staff, consultants, and outside agencies.

Responsibilities

• Lead projects and analyze insurance denial trends.
• Develop and implement procedures and systems to support efficient workflows and maximize reimbursement.
• Assess financial toxicity and screen patients for eligibility and enrolling patients on applicable patient assistance programs.
• Collaborate with providers and pharmacists to assess alternative treatments as appropriate to clinical indication.
• Develop, lead, and maintain expert knowledge of Medicare and insurance contract requirements.
• Provide cost estimates and ensure patients complete the financial process prior to treatment.
• Manage RFIs arising from denials.

Skills

Billing and collections

Insurance workflow

Financial counseling

Medicare & insurance contracts

Communication with patients

Education

HS Diploma/GED

Bachelor's degree

Tools

Billing software

Electronic medical records (EMR)

Job description

UCSF Cancer Services of the Peninsula region is located in San Mateo and Burlingame and services patients receiving cancer care in both the clinic and infusion setting. The Financial Counselor is responsible for all spectrums of screening and assessment of insurance coverage including financial toxicity risk level, facilitates the self-pay workflow, supports off-label treatment authorization, navigates patient and drug assistance programs with patients through the treatment process, and maintains practices and processes that support the financial health of the organization. Primary responsibilities include 1) leading projects and analyzing insurance denial trends, 2) developing and implementing procedures and systems in support of efficient workflows and maximization of reimbursement, 3) assessing for financial toxicity and screening patients for eligibility and enrolling patients on to applicable patient assistance programs, work closely with providers and pharmacists in assessing alternative treatments as appropriate to clinical indication, 4) responsible for developing, leading, and maintaining expert knowledge of Medicare and insurance contract requirements, 5) providing cost estimates and ensures patients complete the financial process prior to treatment, and 6) managing requests for information (RFIs) that arise from denials.

Please note: Certain terms and conditions of employment for this position, including the rate of pay, benefits, etc., are currently subject to negotiation with the appropriate union.

Qualifications

• HS Diploma/GED and four years of relevant work exp. as a Financial Counselor working in an oncology practice OR a Bachelor's degree and three (3) or more years of relevant work experience as a Financial Counselor working in an oncology practice.
• Thorough knowledge of billing and / or collections processes, concepts, systems and external regulations. Knowledge of medical terminology and coding.
• Advanced knowledge of the multiple billing and accounting systems used, including coding, calculating reimbursement rates, filing appeals, conducting interviews and research, and interacting with customers, insurers, and other parties.
• Advanced analytical skills to produce comprehensive reports and identify trends and variations.
• Strong interpersonal and customer service skills to work effectively with all parties to the billing and collection process, and to productively negotiate terms for successful resolution of outstanding accounts and problems.
• Ability to communicate with patients under challenging circumstances on sensitive financial topics.
• Strong ability to provide recommendations on issues of functionality and operations in billing.
• Ability to serve as a resource, providing expertise and education to staff and management at all levels.
• Strong computer proficiency in all relevant hardware and software, with a knowledge of spreadsheet and accounting applications, and a variety of specialized billing and insurance systems.
• Knowledge of patient assistance programs that assist in minimizing the financial toxicity of cancer care and treatment. Ability to access, research, and apply knowledge to serving our patient population while maintaining financial health to the organization.
• Solid interpersonal skills for effective information exchange and problem solving with all levels of management and staff, consultants, and outside agencies.
• The ability to work full-time onsite in Burlingame and San Mateo (alternating days of the week) and the ability to work remotely based on business needs.
• Preferences: - Certified Hematology & Oncology Coder (CHRONC) Please note: Certain terms and conditions of employment for this position, including the rate of pay, benefits, etc., are currently subject to negotiation with the appropriate union.

About UCSF

The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It is the only campus in the 10-campus UC system dedicated exclusively to the health sciences. We bring together the world's leading experts in nearly every area of health. We are home to five Nobel laureates who have advanced the understanding of cancer, neurodegenerative diseases, aging and stem cells.

Pride Values

UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence - also known as https://www.ucsf.edu/about/mission-and-values . In addition to , UCSF is committed to equity - both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available https://diversity.ucsf.edu/ . Join us to find a rewarding career contributing to improving healthcare worldwide.

EEO Statement

The University of California is 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, age, protected veteran status, or other protected status under state or federal law.