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Health Quest Systems, Inc. Oncology Patient Revenue Spec in Poughkeepsie, New York

Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit www.nuvancehealth.org.

The Oncology Patient Revenue Specialist will oversee the system infusion center and medical oncology authorizations in a timely and effective manner to ensure efficient operations and delivery of patient care.

The Oncology Patient Revenue Specialist will oversee the system infusion center and medical oncology authorizations in a timely and effective manner to ensure efficient operations and delivery of patient care.

  • Verifies insurance benefits, obtains authorization, and determines financial liability of all Outpatients undergoing IV, oral chemotherapy or other infusion treatments to identify patients with out-of-pocket expenses.

  • Contacts insurance providers to review patient policies and verifies any insurance benefits due to ensure proper payment.

  • Coordinates payment plans or financial assistance for medication, and facilitates the process of peer-to-peer reviews with Medical Directors at Insurance Co and Medical Oncologists.

  • Complete and verify the Medicare Questionnaire on all Medicare/Medicare HMO encounters.

  • Coordinates time sensitive oral chemo authorization and delivery of medication methodology.

  • Confirms all patient account numbers monthly for accurate billing.

  • Coordinates review with billing office of denial and low reimbursement claims to resolve any upfront billing or pre-cert issues.

  • Examines front end and back end charge entry and billing processes to identify missed charges, inefficient work flow, duplication of effort, errors and rework.

  • Assists in the develop of routine assessments by conducting audits and providing compliance support.

  • In conjunction with the Practice Manager and Director of Revenue Cycle, analyzes monthly reports of claims, receipts, revenue, denials, meaningful use, RVUs and other pertinent data sets and identifies opportunities and implements change management.

  • Stays current with regulatory revisions in payment methodologies, policy and procedures, and reimbursement policies via seminars, websites, etc.

  • Maintain and Model REACH Values (Respect, Excellence, Accountability, Compassion, Honor).

  • Demonstrates regular, reliable and predictable attendance.

  • Performs other duties as required.

Education and Experience Requirements:

  • Bachelor’s degree or equivalent experience.

  • Minimum three (3) years relevant experience in Ambulatory, clinic setting, or insurance company with revenue cycle experience.

Minimum Knowledge, Skills and Abilities Requirements:

  • Detailed oriented.

  • Proficient in Microsoft Office, Excel and Access.

  • Knowledge of healthcare reimbursement and third-party payer guidelines.

  • Strong analytic aptitude.

  • Excellent project management skills.

License, Registration, or Certification Requirements:

  • Healthcare Financial Management Association (HFMA) Certified Revenue Cycle Representative Certification or Certified Healthcare Financial Professional Certification or completed in the first year.

Requisition #: 27399

Primary Shift: Day

Hours Per Week: 40.00

External Company Name: Health Quest Systems, Inc.

External Company URL: www.health-quest.org

Street: 45 Reade Place

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