Infusion Finance Navigator

Medical University of South Carolina; Charleston (SC); On-site; USD 34,000 - 44,000; Full time

Job summary

The Financial Counselor (Infusion) at MUSC Community Physicians provides the financial and information support for infusion therapy. It estimates drug and service costs, verifies insurance benefits, and communicates patient financial responsibility to enable treatment access.

The role handles non-routine cases independently and collaborates with providers, pharmacy, payers, and assistance programs. Key duties include confirming eligibility, interpreting coverage criteria, obtaining letters of

Qualifications

• Prior healthcare customer service experience.
• Working knowledge of medical terminology.
• Prior medical insurance verification experience, including determination of medical versus pharmacy benefit coverage.
• Excellent verbal and written communication skills.
• Insurance knowledge including understanding of medical terminology, ICD-10, CPT, and HCPCS Level II (J-code) drug billing conventions, including NDC and unit reporting.
• Prior cash handling and monetary collection experience.
• Ability to calculate and collect patients’ responsibility and insurance co-pay/coinsurance.
• Experience enrolling patients in and managing manufacturer copay assistance programs, foundation grants, or other third-party funding sources.
• Demonstrated ability to work independently, research unfamiliar issues, and carry a problem through to resolution without day-to-day direction.

Responsibilities

• Verify insurance eligibility and benefits specific to infusion therapy, including deductible, coinsurance, and site-of-care requirements.
• Research payer medical policy and drug coverage criteria for infusion therapies and identify coverage barriers before scheduling.
• Coordinate with provider and pharmacy teams to obtain letters of medical necessity and peer-to-peer reviews.
• Review assigned patient schedules to establish patient financial responsibility.
• Assess treatment plans for active insurance coverage and patient responsibility; communicate unplanned exceptions to the provider.
• Generate estimates of service and review with patient regarding insurance benefits and fiscal responsibility.
• Obtain necessary information from patients for assistance income guidelines when applicable.
• Explain forms such as waivers, payment plans, and assistance applications to patients.
• Provide general education on coverage options and refer to SHIP or Medicaid enrollment resources as needed.
• Manage an assigned caseload, researching unfamiliar drugs, payer requirements, and funding sources; escalate as needed.
• Comply with federal and state laws pertaining to patient care, billing and collections.
• Adhere to Revenue Cycle policies and procedures and perform other duties as assigned.

Skills

Verbal & written communication

Independent problem solving

Self-motivation

Time management

Organizational skills

Education

High school diploma

Bachelor’s degree

Tools

Epic

Excel

Word

Job description

The Financial Counselor (Infusion) at MUSC Community Physicians provides the financial and information support for infusion therapy. It estimates drug and service costs, verifies insurance benefits, and communicates patient financial responsibility to enable treatment access.

The role handles non-routine cases independently and collaborates with providers, pharmacy, payers, and assistance programs. Key duties include confirming eligibility, interpreting coverage criteria, obtaining letters of