Financial Advocate GCM

American Addiction Centers•Charlotte, NC

1d•Remote

About The Position

The Financial Advocate GCM position is a full-time, remote role within the Enterprise Revenue Cycle - Enterprise Financial Assistance department. This role is responsible for assessing patients for potential financial assistance programs through various channels including referrals, online, and paper applications. Key duties involve calculating and communicating patient financial responsibility, explaining complex insurance concepts like deductibles, coinsurance, copayments, and how non-covered or out-of-network services affect costs. The advocate will request upfront payments, establish payment arrangements, and interview uninsured patients to identify financial needs and available assistance programs. This includes coordinating paperwork and applications for potential coverage and continuous follow-up to secure funding for health services. The role also involves initiating credit scoring for Medicaid and charity care eligibility, collaborating with state social workers or outside vendors for Medicaid applications, and maintaining a strong understanding of insurance benefits, companies, and Marketplace options. Furthermore, the Financial Advocate educates physician offices and patients on organizational policies such as Financial Assistance, Patient Financial Responsibility, Non-Covered Services, and Deferral of Care. They coordinate with provider offices for scheduling based on funding needs, stay current on government funding regulations (Medicare and Medicaid), and ensure compliance with internal charity care policies and federal 501R regulations. All patient interactions, including demographic data management and discussions, must be HIPAA-compliant. The advocate will collaborate with peers on operational flows for uninsured patients or those concerned about costs and will serve consumers in diverse settings including virtual, bedside, Emergency Department, clinic, Urgent Care, consult spaces, or a Financial Resource Specialist office. Advocate Health is the third-largest nonprofit, integrated health system in the United States, formed by Advocate Aurora Health and Atrium Health. Headquartered in Charlotte, North Carolina, it serves nearly 6 million patients, employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and is a national leader in clinical innovation and various medical specialties.

Requirements

High School Graduate, or Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).
Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting.
Ability to communicate clearly and proactively to management about issues involving customer service and process improvement opportunities.
Ability to articulate explanations of HIPAA and EMTALA regulations as they relate to all patient interactions within the operational flow involving the Financial Advocate, either virtually or in person.
Solid knowledge of how various types of insurances operate related to denials and appeals processes.
Basic medical coding knowledge.
Understanding of insurances, billing and denials.
Ability to use a combination of scripted notes and clear, written communication when documenting in patients’ accounts.

Responsibilities

Calculates and provides patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service.
Communicates patient liability clearly and accurately while adequately explaining concepts such as deductibles, coinsurance, and/or copayments and how they may affect the cost of care.
Explains how non-covered and out-of-network services factor into the out-of-pocket cost.
Requests upfront payment toward self-pay amounts, including estimated out-of-pocket costs and outstanding previous balances.
Establishes payment arrangements in advance of scheduled services when applicable, communicating due dates and the amount of each installment.
Interviews uninsured patients to assess for qualifying financial needs.
Identifies available assistance programs and coordinates with patient to complete paperwork and applications for any potential coverage(s).
Continues follow-up efforts to obtain a funding source for patient’s health services.
Initiates credit scoring to determine each patient’s eligibility for Medicaid, hospital-sponsored charity care, and other programs through a comprehensive patient interview.
Works in conjunction with state social worker and/or outside eligibility vendor to assist in the appropriate completion of Medicaid applications, ensuring this funding source is maximized based on patients’ eligibility.
Demonstrates working knowledge of insurance benefits, insurance companies, and Marketplace insurance options, and stays informed of other payer sources entering the markets.
Educates physician office/patient on the organization’s applicable policies such as Financial Assistance Policy, Patient Financial Responsibility, Non-Covered Services, and Deferral of Care.
Coordinates with provider office to determine scheduling options based on the need to secure funding and clarify patient’s financial responsibility.
Stays current on regulations and eligibility requirements for government funding, especially Medicare and Medicaid.
Understands and complies with all internal charity care policies and processes.
Understands, complies with, and can articulate federal regulations around 501R.
Performs in a HIPAA-compliant manner with all pertinent patient interviews, including management of demographic data, topics discussed, and actions taken.
Collaborates with peers in the operational flow for uninsured patients or patients that are concerned about costs for upcoming services.
Serves consumers in various settings, including virtual, bedside, Emergency Department room, clinic exam room, Urgent Care, consult space, or a Financial Resource Specialist office.

Benefits

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance