Senior Financial Assistance Specialist

About the role

This position performs Quality Reviews on applications, insurance verifications, and notifications of admission completed by each specialist in the Patient Financial Assistance (PFA) Department for completeness and accuracy. Reviews occur periodically at random and on all denied cases to ensure no opportunities are missed due to timelines or inaccurate processing. The Sr. Financial Assistance Specialist reports quality review results regularly to the Manager of the Patient Financial Assistance department.

Responsibilities

In addition to conducting quality reviews of applications, this role performs comprehensive financial screenings — in person or by telephone interview — to identify all potential payer sources including federal, state, and county assistance programs, and follows through with obtaining and processing the appropriate applications in a timely manner. Screenings are conducted prior to admission whenever possible. The employee ensures the process is expeditious, compassionate, and patient‑friendly, and is accountable for timely coordination and accurate communication of all aspects of the financial assistance process, including timely submission of applications to the appropriate government entity.

This position reviews delayed or denied applications, verifications, and notifications for appropriate processing and education to ensure accounts are financially secured and no reimbursement is lost. The employee uses diplomacy in communicating with patients, guardians, family members, physicians, and co‑workers, and coordinates with the interdisciplinary team (Case Management, Social Services, Nursing, etc.) to ensure a seamless admission and discharge process for all patients referred to the department. The role collects data on accuracy and completeness of all PFA department applications for employee education and to maximize reimbursement, participates in training, and provides reporting to departmental leadership. The Sr. Financial Assistance Specialist also supports the department by training staff, answering questions, monitoring workflows, and serving as a working lead performing full Financial Specialist functions.

• Facilitate the application process for financial assistance with all applicable patients, including pre‑admission, bedside visits while in‑house, and follow‑up after discharge through on‑site or field visits.
• Follow up with patients to obtain all supporting documentation for each application process.
• Maintain documentation on all work activity for each patient account in the appropriate systems.
• Maintain communication/correspondence with patients, representatives, designated family members, appropriate Renown staff, and all government entities on all accounts served.
• Complete application summary forms for FAP Committee review and presentation.
• Monitor all cases processed for financial assistance and by the FAP Committee to completion.
• Complete documentation to justify adjustments for processing by the Central Business Office.
• Issue all decision letters to patients who apply for FAP.
• Ensure all patient co‑pay balances are collected as a result of the FAP approval process.
• Accurately identify all insurance payer sources and payer order sequence.
• Verify insurance eligibility and benefits.
• Provide timely insurance notification.
• Determine estimated cost of services being rendered.
• Identify and collect patient financial obligation amounts (co‑payments, co‑insurance, deductibles, etc.).
• Provide weekly report of application, verification, and notification discrepancies by PFA representative to departmental leadership for training purposes.
• Report trends identified during QA processes to department leadership to ensure maximization of reimbursement.
• Participate in development and deployment of department training modules resulting from QA activities.

This position does not provide patient care.

Qualifications

Education

• Ability to read, write, speak, and understand English sufficiently to perform job duties safely and effectively.
• Bachelor's degree preferred.
• Bilingual candidates (Spanish) will be given preference.
• Requires the ability to perform intermediate math skills.
• Understanding of medical terminology.
• Annual continuing education requirements exist for this position.

Experience

• Minimum two years' experience in commercial medical insurance benefits and eligibility verification, Medicaid screening, applications and/or eligibility, medical financial counseling, medical claims processing, hospital Business Office follow‑up, and/or professional office with customer service financial interaction experience.
• Experience in an acute care hospital preferred.

Certifications

• Ability to obtain and maintain Nevada DWSS Hospital Presumptive Eligibility Certification within 12 months of hire.

Computer / Typing Skills

• Proficient with Microsoft Office Suite (Outlook, PowerPoint, Excel, Teams, Word).
• Ability to use the computer to complete online learning requirements for job‑specific competencies, access online forms and policies, complete online benefits enrollment, etc.
• Experience with EPIC system preferred.