Patient Financial Resolution Advocate

Interprets and applies WVUHS financial policies to make appropriate financial decisions and payment arrangements to ensure the financial viability of WVUHS.

Responsibilities

• Interviews patients who are referred for financial counseling in person or via the telephone to determine financial counseling needs and to help formulate a plan for financial resolution.
• Uses CPT codes to calculate the estimated procedure cost.
• Communicates with the patient the anticipated self-pay portion for upcoming services and explores financial resolution options with the patient.
• Based on information provided by the patient, makes an initial determination if the patient has adequate benefits or qualifies for Medicaid, special programs, or payment arrangements based on federal, state, and hospital policy.
• Refers patients to local, state, and/or federal agencies for assistance as needed.
• Educates patients on their benefits, patient liability, and/or the process for applying for Medicaid, completion of the financial assistance application, and payment alternatives.
• Informs patients of hospital and clinic billing practices/policies and their rights and responsibilities regarding payments.
• Reviews completed financial assistance applications and decides eligibility based on hospital policy.
• Works with specialty departments to establish appropriate financial arrangements for elective services.
• Identifies and accurately resolves potential patient account issues for WVUHS billing departments.
• Monitors daily reports to identify large dollar account balances and private pay patient accounts that need resolution.
• Displays an understanding of third-party payor regulations related to managed care, denials, and reimbursement issues.
• Obtains demographic/billing/insurance information from patient/family/legal guardian and enters it into the registration/billing systems for service and claim processing.
• Obtains and scans patient’s insurance/medical cards and driver’s license into the registration system.
• Has a working knowledge of current hospital contracts with third-party payors.
• Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides the patient a receipt, and documents payment in the registration/billing systems.
• Follows up on accounts as indicated by system flags.
• Balances daily receipts and cash drawer for patient payments, prepares and delivers deposit bag to cashier’s office.
• Initiates auto accident liability coverage. Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems.
• Initiates ERSD (end stage renal disease), Veterans Administration eligibility, Black Lung SSI, Workers Compensation, and Medicare Secondary Payer screenings. Updates registration/billing systems as appropriate.
• Ensures clear and accurate documentation of all patient communications and account activities.
• Uses system software, including online credit card systems.
• Assists in resolving patient billing questions.
• Communicates and interacts with clients, families, visitors, physicians, departmental and hospital staff, and the public in a manner that demonstrates professionalism and concern for individuals' needs.
• Attends departmental meetings and/or documents review of meeting minutes.
• Contacts insurance company or employer to determine eligibility and benefits for requested services.
• Follows up with the patient, insurance company, or provider if there are insurance coverage issues to obtain financial resolution.
• Assists Patient Financial Services, Patient Access, and Care Management with denial management issues.
• Communicates problems hindering workflow to management in a timely manner.
• Prepares WVU Medicine standard consent form, notice of privacy practice, and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures.
• Obtains electronic signature for consent to treat and patient financial obligations.
• Maintains confidentiality according to policy and HIPAA when interacting with patients, physicians, families, co-workers, and the public regarding demographic/clinical/financial information.
• Answers phone calls in a professional and courteous manner. Uses phone system correctly.
• Follows hospital, state, and federal guidelines for ensuring a safe environment for workers, patients, and the public.
• Ensures compliance by staff to hospital, governmental, and insurance regulations.
• Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability, and efficiency.
• Utilizes payer portals and payer websites to verify eligibility.
• Participates in educational programs to meet mandatory requirements and identified needs regarding professional growth.
• Researches and processes mail returns.
• Develops and maintains working knowledge of all federal, state, and local regulations pertaining to hospital billing.
• Monitors accounts to facilitate timely follow-up for financial resolution.
• Provides excellent customer service to patients, visitors, and employees.
• Participates in performance improvement initiatives as requested.
• Obtains Certified Revenue Cycle Representative (CRCR) Certification within 1 year.

Requirements

• High school graduate or equivalent.
• Two (2) years of experience in a healthcare setting (preferred).

Skills

• Ability to accurately utilize applicable computer software and equipment for access processing.
• Demonstrates ability to follow established computer downtime procedures.
• Must have reading and comprehension ability.
• Must be able to communicate effectively.
• Must be able to read and write legibly in English.
• Excellent oral and written communication skills.
• Working knowledge of computers.
• Basic knowledge of medical terminology.
• Basic knowledge of third-party payors (preferred).
• Basic knowledge of time-of-service collection procedures (preferred).
• Basic knowledge of business math (preferred).
• Basic knowledge of ICD-9 and CPT coding (preferred).
• Excellent customer service and telephone etiquette.
• Must demonstrate the ability to use tact and diplomacy in dealing with others.

Physical Requirements

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing duties throughout the work shift.
• Must be able to sit for extended periods of time.
• Visual acuity must be within normal range.
• Must be able to exert more than 50 pounds of force occasionally to move patients or objects.
• Must have manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.

Working Environment

• Office-type environment.
• Patient care environment.

Schedule

Scheduled Weekly Hours: 40

Shift: United States of America (Non-Exempt)