Patient Advocate

Job Summary The patient advocate provides financial counseling services through direct and indirect consultation with patients. This can be done either through Pre Service Financial clearance via telephone or through direct patient contact. Responsible for understanding the patient's financial standing, determining a financial course of action based on the standing, and seeking financial assistance programs if necessary. Understands the coordination of insurance benefits, screens and approves state financial assistance programs, and knowledgeable of PPMH payment options and guidelines. Possesses the ability to estimate patient liability based on treatment plans/pre-certification, and deliver estimation to the patient or their family. Collects funds for co-insurance, co-pay, and deductible. Obtains accurate patient demographics and insurance information to be used for billing and reimbursement purposes. Responsible for educating patients and designated individuals on their rights and responsibilities as a hospital patient and or guarantor, as well as securing all federal and state mandated forms (i.e., self-pay forms, Joint Commission, HIPAA, Advance Directives, waivers, Advance Beneficiary Notices, Medicare Secondary Payer Questionnaire, etc.). Senses emotionally sensitive financial situations and mitigates family burden; and works continuously with the patient during treatment to adjust financial programs if needed and if applicable. Qualifications Associate's Degree in a related field Required or High School Diploma or GED and 4 years additional relevant experience Required Work Experience 1 or more years experience in healthcare financial counseling in a patient registration environment Required 1or more years of experience in healthcare registration or experience obtained through a financial institution, collection agency or similar work environment. Required Licenses and Certifications CPAR Certification within 1-1/2 Yrs Required ACA Certification Upon Hire Required Essential Functions The Patient Advocate provides financial counseling services through direct and indirect consultation with patients. Monitors status and utilizes criteria to screen all scheduled appointments in various departments to address all uninsured, high deductible and ineligible patients prior to their date of service. Monitors status of point of service collections to facilitate patient financial clearance. Express options for patients that include cost estimates, payments plans, discounts and supplemental financial assistance. Obtain financial data during initial intake of screening application at time of scheduling. Completes a predetermination of pending services, or a financial workup in association with patient needing indigent and charity assistance. This could include, but not limited to: verifying insurance, ensuring that precertification(s) has been obtained, gathering various financial information to be used to confirm indigent or charity assistance. Verifies that prior authorizations and eligibility have been obtained if applicable. If neither task (prior authorization or eligibility) has been completed, then proper action is to be taken such as (not inclusive), contacting Patient Access personnel, notifying immediate management, validating with the insurance carrier(s); running eligibility via online tools, or contacting the insurance carrier. Screens and take applications for financial assistance and assists in obtaining needed information for review from the patient or the guarantor. Coordinates with various government agencies, internal departments, or vendors to gain assistance with Disability, Medicaid, Cancer State Aide, COBRA, etc. Provides support to the patient or guarantor by helping them understand and navigate through their financial responsibility relating to physician and hospital billing, insurance payments and denials, during the course of their treatment. Secures information relative to patient's financial status for collection purposes, estimates patient liability, performs a financial assessment and arranges for payment in full or a payment plan for patients without adequate third party coverage. Assist with administering various State and Federal programs such as the Maternal Grant, Condition Code 44, etc, audit inpatient and observation accounts for accuracy and admission coverage.