Financial Advocate

About the role

This position is responsible for calculating and providing patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service. The role also involves communicating patient liability clearly and accurately, educating patients on insurance concepts, and establishing payment arrangements.

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 adequately 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.
• 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

Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting. No formal education or certification is required.

Qualifications

• High School Graduate, or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).

Skills & Abilities

• 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

• 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.

Benefits

Advocate Health offers a comprehensive suite of Total Rewards, including:

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Education Assistance Program

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. Acts as a liaison between health services and the consumer to provide education on costs, funding possibilities and payment options. Educates consumers on the cost of care and assists them in the planning and management of their financial responsibility. Pre-screens self-pay patients to determine if they are eligible for coverage programs and assists patients or family members with completing financial assistance applications, as necessary.