Organization:

SEBMF-East Bay Medical Foundation

Position Overview:

Supports adult oncology patients and families receiving care in an ambulatory/outpatient cancer center by identifying financial barriers and coordinating resources that may reduce the cost burden of cancer treatment. The role serves as the patient’s primary point of contact for medical insurance and financial counseling, helping patients understand coverage, potential financial responsibility, and available assistance. Works collaboratively with patients, caregivers, oncology providers, nurses, social workers, case managers, authorization coordinators, pharmacy staff, billing teams, patient financial services, and other members of the cancer care team to support timely access to treatment.

Job Description:

Patient Financial Assessment and Navigation

• Conduct timely, compassionate assessments of insurance coverage, out-of-pocket costs, treatment-related expenses, household needs, and financial risk.
• Identify financial barriers that may affect a patient’s ability to begin or continue recommended treatment and develop an individualized navigation plan.
• Meet with patients and families, including during interdisciplinary introductions, to explain insurance coverage, estimated responsibility, available resources, and next steps.
• Serve as the patient liaison for financial matters throughout treatment and follow up on insurance, financial risk, referrals, applications, and unresolved barriers.
• Maintain confidentiality and approach financial discussions with sensitivity, respect, cultural humility, and patient advocacy.

Insurance, Billing, and Financial Assistance

• Verify insurance, check benefits, obtain available patient-responsibility information from payers, and assist patients in maximizing insurance benefits.
• Educate patients about bills, estimates, payment plans, institutional financial assistance policies, discounts, and charity care within the scope of the role.
• Refer patients to social work when additional support or completion of assistance applications.
• Assist eligible patients with applications, required documentation, Medi-Cal enrollment, renewals, and follow-up without guaranteeing approval.
• Apply knowledge of health insurance benefits to hospital and professional charges and maintain awareness of relevant regulations and procedural changes.

Medication, Treatment, and Community Resource Support

• Collaborate with pharmacy, infusion, oncology, and financial services teams to identify opportunities to reduce the cost of oral and infused oncology medications.
• Interact with Medicare, insurance companies, pharmaceutical companies, grants, foundations, nonprofit organizations, and other assistance programs as an advocate for the patient.
• Evaluate and coordinate manufacturer-sponsored copay assistance, patient assistance, free-drug, foundation, state, federal, community, and cancer-specific resources.
• Maintain current knowledge of community resources, financial programs, eligibility requirements, renewal requirements, expiration dates, and changes in patient eligibility.
• Escalate medication or treatment access concerns when financial barriers could delay or interrupt care.

Interdisciplinary Collaboration and Patient Education

• Communicate financial implications, identified barriers, and progress toward resolution with the treatment team while maintaining patient privacy.
• Work closely with oncology providers, nurses, nurse navigators, social work, case management, pharmacy, authorization, registration, billing, and patient financial services to provide coordinated support.
• Explain complex financial and assistance information in clear, understandable language and connect patients and caregivers with appropriate internal and external resources.
• Recognize when financial distress may affect treatment adherence or other needs and refer patients to the appropriate internal team.
• Participate in multidisciplinary case review, cancer care coordination, and professional development activities.

Documentation, Program Development, and Quality Improvement

• Document financial assessments, meeting details, account activity, referrals, applications, resources, recommendations, interventions, and follow-up in patient electronic record; track each account through resolution or appropriate handoff.
• Maintain accurate records of assistance obtained and unresolved barriers in accordance with organizational, regulatory, and program requirements.
• Participate in data collection for quality and research purposes and track appropriate program measures, including patients screened, referrals completed, assistance obtained, and barriers resolved.
• Help develop standardized workflows, screening processes, educational materials, resource directories, and referral pathways that support early financial navigation.
• Monitor recurring patient financial barriers and provide feedback regarding opportunities to reduce financial toxicity and avoidable treatment delays.

 

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma

Bachelor’s degree in finance, business, counseling, social work, public health or a related field

 

 

CERTIFICATIONS & LICENSURE

Association of Cancer Centers Boot Camp within 90 days

Must complete the patient navigation or financial counseling certification from the American Cancer Society within six months of hire.

 

 

TYPICAL EXPERIENCE:

2 recent relevant experience

 

 

SKILLS AND KNOWLEDGE:

• Experience in a community service environment, such as a hospital or welfare agency, including the medical field working with patients’ financial needs.
• Experience in healthcare, patient navigation, financial counseling, social services, oncology, insurance, medical billing, patient financial services, or a related field.
• Knowledge of oncology treatment modalities, including radiation oncology, medical oncology, and gynecologic oncology.
• Understanding of relevant CPT codes, medical terminology, anatomy, insurance benefits, hospital and professional charges, and financial assistance processes.
• Knowledge of community resources and financial programs used to assess and address patients’ financial, healthcare, and basic needs.
• Strong interpersonal, written and verbal communication, organizational, problem-solving, and follow-through skills.
• Ability to interact effectively with patients, families, medical staff, internal departments, payers, pharmaceutical companies, and outside agencies.
• Ability to manage multiple patients, applications, deadlines, and follow-up activities in a complex systems environment.
• Proficiency with electronic health records, spreadsheets, standard computer applications, and other business technologies.
• Ability to grasp, retain, and apply new regulations and procedural changes and to handle stressful, sensitive situations involving seriously ill patients and financial concerns.
• Demonstrated commitment to confidentiality, patient advocacy, professionalism, cultural sensitivity, and equitable access to care.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Pay Range is $38.20 to $53.48 / hour

The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.