Financial Family Medicaid Advocate

Nemours Children's Health•Wilmington, DE

7d•Hybrid

About The Position

Nemours is seeking a compassionate and detail-oriented Financial Family Medicaid Specialist Advocate to assist families in navigating the financial aspects of their care. This role involves using customer service, healthcare finance knowledge, and communication skills to educate patients and families about the financial implications of treatment at Nemours. The advocate will conduct interviews, gather and review sensitive financial information for Nemours Financial Assistance and Medicaid Programs. Responsibilities include working with insurance carriers and internal teams to determine benefit levels, coordination of benefits, coinsurance, and deductible amounts, and communicating financial obligations. The role is responsible for identifying suitable financial assistance programs, developing payment arrangements, and collecting payments. Additionally, the advocate will research and address inquiries related to insurance regulations, charge discrepancies, benefit interpretation, and claims adjudication, and support Medicaid enrollment processes for DE/PA/NJ Medicaid programs. Some travel to other Nemours locations may be required.

Requirements

Associates degree or 1 year of specialized training beyond high school required
Minimal of 3 years of relevant work experience required

Nice To Haves

CHAA (Certified Healthcare Access Associate), CRCR (Certified Revenue Cycle Representative) or CAC (Certified Application Counselor) preferred

Responsibilities

Convey courtesy, dignity, respect and a positive attitude through words and actions to establish harmonious relationships with all individuals.
Demonstrate effective communication and respect by using active listening skills, positive body language and effective verbal, written and electronic forms of communication.
Demonstrate care and concern and inclusion when interacting with and informing customers by consistently using A.I.D.E.T and protecting confidentiality and privacy.
Utilize daily work queues, reports and schedules to identify and make contact with underinsured/uninsured patients to assist them in meeting their financial obligations for care by applying internal policies/procedures and external resources-such as Medicaid programs.
Interview patients/families to obtain comprehensive financial information and based on this information, advise them on available financial assistance/Medicaid programs and assist them with applications and/or enrollments.
Respond timely and appropriately to all internal referral requests and external customer phone calls to ensure that all issues are resolved in accordance with departmental standard workflows. This includes but is not limited to- billing inquiries, charity care applications, payment plan requests, accounts requiring special consideration, researching high dollar and newborn accounts.
Collaborate with Authorization and Patient Cost Estimate teams to promptly identify self-pay patients, patients with high out of pocket expenses or with a non-contracted insurance carrier.
Meet daily/weekly/monthly goals and expectations: call center metrics and recording evaluations, accurate payment posting, self-pay screening and account follow up guidelines, and account documentation.
Ensure that payment plans, discounts, special services funding, charity care, and receipt of payments are accurately assigned to accounts, properly documented and reconciled daily.
Coordinate with insurance carriers to verify eligibility and determine healthcare benefits particularly as it relates to out-of-pocket expenses for the patient and/or patient’s family and confirm that documented information is accurate and current, including demographic information.