Case Manager, Patient Financial Services
: Job Details :

Pay Range: $108,400.00-$173,400.00 Company Overview:

The people of Memorial Sloan Kettering Cancer Center (MSK) are united by a singular mission: ending cancer for life. Our specialized care teams provide personalized, compassionate, expert care to patients of all ages. Informed by basic research done at our Sloan Kettering Institute, scientists across MSK collaborate to conduct innovative translational and clinical research that is driving a revolution in our understanding of cancer as a disease and improving the ability to prevent, diagnose, and treat it. MSK is dedicated to training the next generation of scientists and clinicians, who go on to pursue?our mission?at MSK and around the globe.

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Job Description:

Exciting Opportunity at MSK: Case Manager, Patient Financial Services

The Case Manager, Patient Financial Services role is responsible for facilitating insurance authorization to ensure patient access to care in a complex insurance landscape. Collaborates with multiple key stakeholders to ensure clinical treatment plans meet insurance and regulatory requirements.

Role Overview:

• Utilize clinical nursing expertise to evaluate referrals received and treatment orders against uniqueness criteria, to ensure regulatory compliance, setting case priority strategy development for payor challenges.
• Monitor status of submitted requests and ensure all appropriate parties (Clinical teams, pharmacy, revenue department, non-clinical PFS teams) are notified of determinations
• Oversee the financial clearance of treatment plans for an assigned caseload of patients, inclusive of oncologic treatment orders, non-oncologic treatment orders, or a combination of both
• Collaborate with clinical and non-clinical teams to collect necessary supporting documentation including but not limited to letters of medical necessity.
• Adheres to all documentation guidelines; uses departmental program, RMS & email applications to record patient activity and outcomes related to interventions; records authorization numbers and other pertinent data required for proper adjudication of claims.

Key Qualifications:

• Maintains current NY State licensure
• Continuously assesses and evaluates personal knowledge and practice in the field of managed care, oncology & case management and stays current on trends in managed care and reimbursement as it affects patient benefits and coverage
• Be able to explains hospital and physician billing policies, procedures, and coverage guidelines in such a way as to gain individuals understanding and cooperation.
• Coordinates and counsels staff/patient/family members to other MSKCC departments (i.e., PFS, Social Work, and Administration) as appropriate for Financial Evaluation, Medicaid Application, and Medical Necessity Application

Core Skills:

• Strong communication skills
• Experience working with Insurance, processing appeals and denials.
• Case Management experience strongly preferred
• Working knowledge of NCCN guidelines, ASTRO guidelines, and FDA guidelines

Additional Information:

Location: 633 3rd Ave when on site, Biweekly onsite presence as required by department needs

Schedule: 9:00 AM 5:00 PM EST, Monday - Friday

Reporting To: Associate Clinical Director, Patient Financial Service

Pay Range: $106,500.00-$170,400.00

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Closing:

MSK is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sexual orientation, national origin, age, religion, creed, disability, veteran status or any other factor which cannot lawfully be used as a basis for an employment decision.

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