Financial Advocate
About The Position
The Financial Advocate is responsible for calculating and providing patients with personalized estimates of their financial responsibility based on insurance coverage prior to service. This role involves clearly and accurately communicating patient liability, explaining concepts like deductibles, coinsurance, and copayments, and how non-covered or out-of-network services affect out-of-pocket costs. The Financial Advocate also requests upfront payments, establishes payment arrangements, interviews uninsured patients to assess financial needs, identifies assistance programs, and coordinates with patients to complete necessary paperwork. They initiate credit scoring to determine eligibility for Medicaid, hospital-sponsored charity care, and other programs, and work with social workers or vendors to ensure Medicaid applications are completed appropriately. Additionally, the role requires a strong understanding of insurance benefits, payer sources, and relevant regulations, including HIPAA and federal regulations around 501R. The Financial Advocate educates offices and patients on applicable policies and collaborates with peers to support uninsured patients or those concerned about costs, serving consumers in various settings.
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.
- Has 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
- Comprehensive suite of Total Rewards: benefits and well-being programs
- Competitive compensation
- Generous retirement offerings
- Programs that invest in your career development
- 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
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
