Financial Advocate

Responsibilities

• Calculates and provides patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service.
• Communicates patient liability clearly and accurately while explaining concepts such as deductibles, coinsurance, and/or copayments and how they may affect the cost of care.
• Explains how non-covered and out-of-network services factor into the out-of-pocket cost.
• Requests upfront payment toward self-pay amounts, including estimated out-of-pocket costs and outstanding previous balances.
• Establishes payment arrangements in advance of scheduled services when applicable, communicating due dates and the amount of each installment.
• Interviews uninsured patients to assess for qualifying financial needs. Identifies available assistance programs and coordinates with patient to complete paperwork and applications for any potential coverage(s).
• Continues follow-up efforts to obtain a funding source for patient’s health services.
• Initiates credit scoring to determine each patient’s eligibility for Medicaid, hospital-sponsored charity care, and other programs through a comprehensive patient interview.
• Works in conjunction with state social worker and/or outside eligibility vendor to assist in the appropriate completion of Medicaid applications, ensuring this funding source is maximized based on patients’ eligibility.
• Demonstrates working knowledge of insurance benefits, insurance companies, and Marketplace insurance options, and stays informed of other payer sources entering the markets.
• Educates physician office/patient on the organization’s applicable policies such as Financial Assistance Policy, Patient Financial Responsibility, Non-Covered Services, and Deferral of Care.
• Coordinates with provider office to determine scheduling options based on the need to secure funding and clarify patient’s financial responsibility.
• Stays current on regulations and eligibility requirements for government funding, especially Medicare and Medicaid.
• Understands and complies with all internal charity care policies and processes.
• Understands, complies with, and can articulate federal regulations around 501R.
• Performs in a HIPAA-compliant manner with all pertinent patient interviews, including management of demographic data, topics discussed, and actions taken.
• Collaborates with peers in the operational flow for uninsured patients or patients that are concerned about costs for upcoming services.
• Serves consumers in various settings, including virtual, bedside, Emergency Department room, clinic exam room, Urgent Care, consult space, or a Financial Resource Specialist office.

Requirements

• High School Graduate, or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).
• Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting.

Skills

• Ability to communicate clearly and proactively to management about issues involving customer service and process improvement opportunities.
• Ability to articulate explanations of HIPAA and EMTALA regulations as they relate to all patient interactions within the operational flow involving the Financial Advocate, either virtually or in person.
• Solid knowledge of how various types of insurances operate related to denials and appeals processes.
• Basic medical coding knowledge.
• Understanding of insurances, billing, and denials.
• Ability to use a combination of scripted notes and clear, written communication when documenting in patients’ accounts.

Physical Requirements and Working Conditions

• This position requires travel, therefore, will be exposed to weather and road conditions.
• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.
• Must be able to sit a majority of the workday.
• Occasionally lift up to 10 lbs.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.