Patient Financial Advocate Senior

Key Responsibilities

• Manage inbound escalations from Patient Services Representatives.
• Conduct detailed account reviews within NextGen PMS to reconcile complex balances.
• Investigate payment discrepancies, insurance processing issues, and posting errors.
• Cross-functionally coordinate with internal RCM, Operations, and payer teams for resolution.
• Identify and recommend workflow improvements for recurring patient complaints.
• Process and make recommendations on Financial Hardship Applications.

Financial Advocacy and Payment Solutions

• Evaluate hardship considerations and assist patients with financial assistance applications.
• Discuss high-balance accounts with sensitivity and professionalism.
• Support prevention of external collections placement through proactive resolution.
• Guide patients through insurance explanations, appeals guidance (when appropriate), and benefit education.

Escalation and De-escalation

• Handle emotionally charged or complex patient interactions with professionalism.
• Apply conflict resolution techniques to maintain trust and positive patient relationships.
• Serve as an escalation point for unresolved complaints before leadership involvement.
• Maintain composure and sound judgment under pressure.

Documentation and Compliance

• Maintain detailed, structured documentation within patient accounts.
• Ensure all payment arrangements and adjustments are clearly noted and policy compliant.
• Follow HIPAA and organizational privacy standards.
• Adhere to internal financial assistance and adjustment policies.

Revenue Impact and Performance

• Support organizational goals related to:
• Reduction in aging accounts
• Decrease in external collections referrals
• Improved payment plan adherence
• Increased patient satisfaction scores
• Monitor promise-to-pay compliance and initiate follow-up outreach when necessary.
• Participate in QA review and mentor Tier 1 representatives as needed.

Patient Services Center Operations and Dashboard Monitoring

• Monitor daily call center performance metrics including call volume, abandonment rate, ASA, AHT, and service level adherence.
• Identify trends in peak call times and recommend staffing or workflow adjustments to maintain service levels.
• Proactively address elevated abandonment rates or extended hold times by partnering with the Supervisor to implement corrective actions.
• Review call data to identify recurring patient concerns, billing confusion trends, or systemic process gaps.
• Support quality assurance initiatives by correlating performance metrics with call outcomes and patient satisfaction indicators.
• Develop performance improvement plans when dashboard trends indicate service risks.
• Absorb high-volume periods to ensure service level consistency.

Qualifications

• High school diploma or equivalent.
• 4+ years experience in healthcare revenue cycle, patient accounts, or medical billing.
• Advanced understanding of insurance processing, EOB interpretation, and patient responsibility.
• Experience handling escalated patient financial conversations.
• Strong system navigation skills (NextGen PMS experience preferred).
• Demonstrated ability to manage complex accounts independently.
• Intermediate computer skills and proficiency in MS Word, Excel, Outlook, and database management and internet usage.
• 5+ years experience in healthcare revenue cycle and patient account management (Preferred).
• Prior call center or high-volume inbound call experience (Preferred).
• Advanced understanding of insurance processing, EOB interpretation, and patient responsibility (Preferred).
• Experience handling escalated patient financial conversations (Preferred).
• Strong system navigation skills (Preferred).
• (Preferred).
• Demonstrated ability to manage complex accounts independently (Preferred).
• Certified Revenue Cycle Representative or other billing certification (Preferred).

Core Competencies

• Advanced communication and negotiation skills.
• Emotional intelligence and empathy.
• Analytical problem-solving.
• Attention to detail.
• Accountability and ownership.
• Cross-functional collaboration.
• Professional judgment and discretion.

Benefits

• Competitive compensation and a wide range of benefits, including medical, dental, vision, low-cost virtual care, dependent and domestic partner coverage, 401K, and more, designed to support your well-being and financial security.
• Immerse yourself in a community united by a deep commitment to enhance mental health and revolutionize patient care.
• Play a pivotal role in reshaping behavioral health, with your efforts directly improving patient lives.
• Thrive in an environment that celebrates collaborative success, driven by effective communication and unity.
• Receive comprehensive onboarding and ongoing educational resources, tailored to cultivate your talents and assure your triumph in your role.

About the Role

Transformations Care Network (TCN) is committed to fair and equitable compensation practices. The hourly compensation range for this role is $23 - $26. Actual compensation may vary based on licensure, experience, market-driven enhancements, and incentive opportunities available for this role.

Transformations Care Network is an equal opportunity employer, committed to fostering an inclusive and diverse workplace.