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Company: UchicagoMedicine
Location: Chicago, IL
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech


Cancer Insurance Specialist

Location: Hyde Park, IL

The Finance Revenue Cycle Department has an opportunity for a Cancer Insurance Specialist to complete pre-registration, insurance verification and payor authorizations of inpatients and outpatients at UChicago Medicine.

Cancer Insurance Research Specialist – Job Summary

In this role, the Cancer Insurance Specialist will be responsible for pre-registration, insurance verification and payor authorizations of inpatients and outpatients, and educating patients about their financial responsibilities and resources.

  • Works with patient and families and collaborates with members of the clinical and administrative team, including Patient Access and Call Center teams, from the point of initial referral through clinical evaluation, and continuing through active treatment and for follow-up visits.
  • Requires extensive utilization of Hospital revenue systems, and continuous interaction with patients, physicians, insurance companies, and other member of the Hospitals and Biological Science Division staff.
  • Routinely interacts with the insurance companies to ensure proper payments for all cancer-related services, and serves as an advocate for the patient when billing problems occur.
  • The (Cancer) Insurance Specialist advises patients of anticipated costs.
  • Works with health insurance providers to determine coverage, benefit limits, and financial responsibility.
  • Uses the patients' electronic health record to both access and document information which supports authorization, therefore, ensuring a systematic approach to sharing critical information.
  • Networks with other precertification/insurance employees across UCM's billing entities to stay abreast of and share recent changes, updates, and processes.
  • Provides complete information to the Single Case Agreement Team on initial request in an effort to facilitate a standardized and systematic process for non-par insurance plans.
  • Maintains and develops clear lines of communication with insurance representatives from multiple insurance companies who can provide precertification/authorization guidelines unique to their company.

Insurance Specialist – Essential Job Functions

  • Collects and verifies demographic information, insurance coverage, plan benefits, and referring physician data for (cancer) patients. Uses all necessary and available electronic systems and tools.
  • Discusses in-person (preferred), or telephonically, benefits and financial information with all referred (cancer) patients and their families prior to initial evaluation. Provides face-to-face or telephonic financial counseling and information regarding the insurance to patients, families, and related Hospital staff.
  • Obtains detailed patient insurance benefit information from point of initial referral, including initial consult, diagnostic work-up, hospitalization(s), and follow-up clinic visits.
  • Collaborates with Social Worker and/or Pharmacy to provide information to patients and their families regarding available financial assistance resources. Assists patients in completing necessary documents to apply for financial assistance, free care, special pharmacy benefits, etc.
  • Assists patients in answering billing questions and facilitates resolution of issues.
  • Communicates/Educate family and/or responsible party, as necessary, to inform them of any insurance problems or restrictions, ensuring that insurance information is clearly relayed to and understood by family and/or responsible party.
  • Completes abbreviated assessment to determine family eligibility for Charity Care programs, for handoff to Revenue Cycle's approvals team (located offsite in Darien office).
  • Communicates and coordinates as necessary with Patient Access team to share information and reduce redundancy.
  • Initiates appropriate handoffs to other insurance specialists and departments, as patient moves from one clinical service, to another, to ensue continuous monitoring of benefits and obligations, while communicating same among colleagues.
  • Communicates initially with Call Center regarding intake information, and then proactively and directly with the clinical team , regarding status of authorization and the need for clinical documentation
  • Monitors and updates information regarding insurance data, physicians, authorizations, and preferred providers.
  • Obtains all necessary payor authorizations for cancer care. Verifies coverage and other medical benefits and acquires necessary referrals and authorizations. Confirms pre- authorizations for procedures. Verifies receipt of and facilitates managed care referrals for office visits.
  • Documents insurance coverage and authorization information in EPIC. Documents all relevant information into EPIC
  • Partners with Single Case Agreement Department to facilitate non-par cases to obtain care/treatment.
  • Responds to incoming calls regarding account status from patients and insurance companies.
  • Performs other duties assigned.

Cancer Insurance Specialist - Qualifications

  • Education : Bachelor's degree, or equivalent, and/or 2 years' experience working in medical insurance verification and./or other healthcare finance areas.
  • 5+ years related healthcare registration, billing and/or reimbursement experience required.
  • Advanced insurance authorization and registration techniques required
  • Previous experience in complex clinical setting that required coordination of multiple services
  • Website Insurance Training/Experience (Navinet, WebMD, Passport)
  • EPIC training/testing/experience (Prelude/Cadence Preferred).
  • Registration Essential knowlage
  • Windows-based PC experience

Cancer Insurance Specialist - MISC Qualifications

  • Ability to schedule and register patients rapidly and accurately.
  • Strong communication skills and must be able to communicate courteously and effectively with physicians, payors, and staff.
  • Must be a self-motivated
  • Individual must be highly organized and dependable, and able to work with minimum of supervision
  • Ability to prioritize and work on several projects at once while maintaining communication with all invested parties.
  • Ability to complete multiple tasks and work under pressure and in stressful situations
  • Ability to quickly learn new procedures.
  • Ability to display compassion and empathy
  • Ability to maintain confidentiality of patient information.
  • Embodies a compassionate and tactful manner.
  • Strong communication skills, attention to detail, problem solving and a high degree of organization are critical qualities
  • Must be able to effectively manage work across departments, work independently with minimal supervision, and participate in administrative decisions.

Cancer Insurance Specialist - Preferred Qualifications

  • Resource scheduling experience preferred (e.g. ancillary testing)
  • Background in medical terminology; (Oncology) experience preferred

Why Join Us?

We've been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We're in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you'd like to add enriching human life to your profile, The University of Chicago Medicine is for you. Here at the forefront, we're doing work that really matters. Join us. Bring your passion.

Bring your career to the next level at a hospital that is thriving; from patient satisfaction to employee engagement, we are at the Forefront of Medicine. Take advantage of all we have to offer and #BringYourPassiontotheForefront

University of Chicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: www.uchospitals.edu/jobs

The University of Chicago Medical Center is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

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