Financial Advocate

Sanford Health•Sioux Falls, SD

7d•$19 - $31•Onsite

About The Position

Provides financial advocacy counseling to patients/families including topics of insurance coverage, treatment coverage, prompt pay and financial hardship discounts to patients and family members. Responsible for screening 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. Responsible for identifying all sources of potential payers including Commercial Insurance, Private Insurance, etc. Also responsible for providing and completing the Financial Assistance Application form and assisting 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. Completes prior authorization as necessary. Works with patients to ensure continued eligibility and ensure re-certifications. Contacts appropriate agencies to obtain information and paperwork necessary to process patient's assistance applications. These resources can include state caseworkers, banks, employers, Social Security Administration, medical facilities, and insurance companies. Assist with patient assistance programs offered by pharmaceutical companies, state governments and nonprofit groups. Educates 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. Ensures avenues of reimbursement or assistance are pursued for uninsured and underinsured patients. Refers patients to other agencies for assistance when needed and discusses the financial statement process relating to payment options and hospital assistance, including grants. Follows up in obtaining missing insurance information, patient demographics, etc., on patient accounts for the proper handling in the billing office. Complete price estimates. Completes annual review of insurance pamphlet and coverage options as mandated by Conditions for Coverage. Communicates 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. Complies with other job-related responsibilities as directed by Leadership. Demonstrates a caring and respectful attitude to all patients, family members, visitors and fellow employees as defined in the mission and values of the organization.

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.
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.