Patient Advocate

About the Role

The patient advocate provides financial counseling services through direct and indirect consultation with patients, either via telephone for pre-service financial clearance or through direct patient contact. Responsibilities include understanding the patient's financial standing, determining appropriate financial actions, and seeking financial assistance programs when necessary.

Key areas of expertise include coordination of insurance benefits, screening and approval of state financial assistance programs, and knowledge of payment options and guidelines. The advocate estimates patient liability based on treatment plans, delivers estimates to patients or their families, and collects funds for co-insurance, co-pay, and deductible.

Additional duties involve obtaining accurate patient demographics and insurance information for billing, educating patients on their rights and responsibilities, and securing all mandated federal and state forms (e.g., self-pay forms, HIPAA, Advance Directives, waivers, Advance Beneficiary Notices). The advocate also addresses emotionally sensitive financial situations, mitigates family burden, and adjusts financial programs during treatment as needed.

Responsibilities

• Provide financial counseling services through direct and indirect consultation with patients.
• Monitor and screen scheduled appointments to address uninsured, high-deductible, and ineligible patients prior to service.
• Facilitate point-of-service collections to ensure patient financial clearance.
• Present financial options to patients, including cost estimates, payment plans, discounts, and supplemental financial assistance.
• Obtain financial data during initial intake and screening at the time of scheduling.
• Complete predetermination of pending services or financial workups for patients needing indigent or charity assistance, including verifying insurance, ensuring precertification, and gathering financial information.
• Verify prior authorizations and eligibility; take corrective action if these are incomplete (e.g., contacting Patient Access, notifying management, validating with insurance carriers).
• Screen and process applications for financial assistance, assisting patients or guarantors in obtaining required information.
• Coordinate with government agencies, internal departments, or vendors to assist with programs such as Disability, Medicaid, Cancer State Aide, and COBRA.
• Support patients or guarantors in understanding their financial responsibilities related to physician and hospital billing, insurance payments, and denials.
• Secure information on patient financial status for collection purposes, estimate patient liability, perform financial assessments, and arrange payment plans for patients without adequate third-party coverage.
• Assist with administering State and Federal programs (e.g., Maternal Grant, Condition Code 44) and audit inpatient and observation accounts for accuracy and admission coverage.

Requirements

• Associate's Degree in a related field or High School Diploma/GED with 4 years of additional relevant experience.
• 1 or more years of experience in healthcare financial counseling in a patient registration environment.
• 1 or more years of experience in healthcare registration or a similar role in a financial institution, collection agency, or related environment.

Qualifications

• CPAR Certification within 1.5 years of hire.
• ACA Certification upon hire.