Financial Advocate - Onsite

About the role

The primary responsibility of this role is assisting uninsured and underinsured patients with obtaining healthcare coverage, including Medicaid, Marketplace plans, and other available financial assistance programs.

Responsibilities

• Meet with patients and families at the bedside while patients are hospitalized, conduct face-to-face interviews, gather financial and household information, complete Medicaid and Marketplace applications, obtain required documentation, and follow up on pending eligibility determinations.
• Work closely with Care Management, Social Work, Nursing, Registration, and other interdisciplinary teams to support patient coverage needs and facilitate discharge planning.
• Communicate 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.
• Request upfront payment toward self-pay amounts, including estimated out-of-pocket costs and outstanding previous balances.
• Establish payment arrangements in advance of scheduled services when applicable, communicating due dates and the amount of each installment.
• Interview uninsured patients to assess for qualifying financial needs. Identify available assistance programs and coordinate with patient to complete paperwork and applications for any potential coverage(s).
• Continue follow-up efforts to obtain a funding source for patient’s health services.
• Initiate credit scoring to determine each patient’s eligibility for Medicaid, hospital-sponsored charity care, and other programs through a comprehensive patient interview.
• Work 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.
• Demonstrate working knowledge of insurance benefits, insurance companies, and Marketplace insurance options, and stay informed of other payer sources entering the markets.
• Educate physician office/patient on the organization’s applicable policies such as Financial Assistance Policy, Patient Financial Responsibility, Non-Covered Services, and Deferral of Care.
• Coordinate with provider office to determine scheduling options based on the need to secure funding and clarify patient’s financial responsibility.
• Stay current on regulations and eligibility requirements for government funding, especially Medicare and Medicaid. Understand and comply with all internal charity care policies and processes.
• Understand and can articulate federal regulations around 501R.
• Perform in a HIPAA-compliant manner with all pertinent patient interviews, including management of demographic data, topics discussed, and actions taken.
• Collaborate with peers in the operational flow for uninsured patients or patients that are concerned about costs for upcoming services.
• Serve consumers in various settings, including virtual, bedside, Emergency Department room, clinic exam room, Urgent Care, consult space, or a Financial Resource Specialist office.

Requirements

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.

Qualifications

Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting.

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.

Benefits

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
Educational Assistance Program