Financial Advocate

Sanford Health • Sioux Falls, SD

4d • Onsite

About The Position

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. This role provides financial advocacy counseling to patients/families, covering topics such as insurance coverage, treatment coverage, prompt pay, and financial hardship discounts. The Financial Advocate is responsible for screening self-pay patients, evaluating their eligibility for various governmental and non-governmental programs, and assisting them in meeting their financial obligations. This includes discussing agreeable payment plans, identifying all potential payers, and assisting patients with financial assistance applications and benefit applications. The role also involves determining patient eligibility for assistance programs, conducting insurance benefit investigations, completing prior authorizations, and ensuring continued patient eligibility and re-certifications. The Financial Advocate will also work with pharmaceutical companies, state governments, and nonprofit groups to assist with patient assistance programs, educate patients on available sponsorship programs (e.g., Medicare, Medicaid), and assist with FMLA and Disability paperwork. Navigating the Medicare System to ensure accurate benefit start dates and correct primary insurance is also a key responsibility. The role ensures avenues of reimbursement or assistance are pursued for uninsured and underinsured patients, refers patients to other agencies when needed, and discusses payment options and hospital assistance, including grants. Follow-up on missing insurance information and patient demographics is required for proper billing office handling. The Financial Advocate will also complete price estimates and annual reviews of insurance pamphlets and coverage options as mandated. Communication with supervisors and various departments such as Nursing, Physicians, Case Management, Social Work, Patient Access, Patient Relations, Quality Resource Management, and Social Services is essential to address patient concerns. The role also includes other job-related responsibilities as directed by Leadership and requires demonstrating a caring and respectful attitude towards all patients, family members, visitors, and fellow employees.

Requirements

• Bachelor’s degree in social work, case management, public relations or related field required.
• In lieu of degree, consideration may be given to six years equivalent work experience.

Nice To Haves

• Previous experience in healthcare services or health insurance would be beneficial, but not required.

Responsibilities

• Screen self-pay patients and evaluate them to determine eligibility in various governmental and non-governmental programs to ensure patients are assisted in meeting their financial obligations.
• Discuss agreeable payment plans with qualified patients.
• Identify all sources of potential payers including Commercial Insurance, Private Insurance, etc.
• Provide and complete the Financial Assistance Application form and assist patients in the process of applying for any benefits for which they may be eligible.
• Determine patient eligibility for assistance programs through interviews and screening processes.
• Complete an insurance benefit investigation for all new/transferring patients as appropriate.
• Complete prior authorization as necessary.
• Work with patients to ensure continued eligibility and ensure re-certifications.
• Contact appropriate agencies to obtain information and paperwork necessary to process patient's assistance applications.
• Assist with patient assistance programs offered by pharmaceutical companies, state governments and nonprofit groups.
• Educate patients on various sponsorship programs available based on eligibility including but not limited to Medicare, Supplemental Security Income, Social Security Disability, Medicaid programs, County eligibility, and Indian Health Services.
• Assist with completing FMLA and Disability paperwork requirements.
• Assist patients to navigate the Medicare System to ensure benefit start dates are accurate, correct insurance is primary, ESRD benefits, etc.
• Ensure avenues of reimbursement or assistance are pursued for uninsured and underinsured patients.
• Refer patients to other agencies for assistance when needed and discuss the financial statement process relating to payment options and hospital assistance, including grants.
• Follow up in obtaining missing insurance information, patient demographics, etc., on patient accounts for the proper handling in the billing office.
• Complete price estimates.
• Complete annual review of insurance pamphlet and coverage options as mandated by Conditions for Coverage.
• Communicate with supervisor and various departments such as Nursing, Physicians, Case Management, Social Work, Patient Access, Patient Relations, Quality Resource Management and Social Services to address patient concerns.
• Comply with other job-related responsibilities as directed by Leadership.
• Demonstrate a caring and respectful attitude to all patients, family members, visitors and fellow employees as defined in the mission and values of the organization.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level