UMH Sparrow - PATIENT FINANCIAL ADVOCATE

Sparrow•Lansing, MI

26d

About The Position

Under the general supervision of the Director Patient Access, the Patient Financial Advocate defines and implements best practices to support patients facing unexpected financial obligations or loss of insurance coverage. The role uses fact-finding, data analysis, case reviews, auditing, gap analysis, and industry best practices to streamline work and close identified gaps, communicating solutions, issues, and risks to management and other responsible entities. The position advocates for patients experiencing complex financial, billing, counseling, or authorization issues and manages ongoing financial care for patients and families throughout their medical care at Michigan Medicine. It monitors complex patient financial situations and coordinates with patients, families, attorneys, assistance programs, insurance companies, internal teams, and external customers. The role supports Sparrow communities, including rural health clinics and programs, through community outreach and education. This includes helping reduce uninsured rates in the named counties, educating people about health insurance, plans, and networks, increasing Marketplace and Medicaid enrollment, enrolling patients in ACA and Medicaid plans, and working with DHHS workers on pending applications. The position also trains staff, partners with vendors and other organizations, contributes to KPI and metrics reporting, and analyzes business and user needs and process or system issues. Other related duties and departmental projects may be assigned based on workload and needs.

Requirements

Bachelor’s degree in Business Administration, Health Care Administration, or a related field, plus at least 2 years as a patient financial counselor assisting patients with complex medical billing issues and at least 2 years of billing and/or claims experience in Revenue Cycle or a healthcare setting with progressive responsibility, or completion of an accredited billing and claims processing program; alternatively, an associate degree in business or a related field with at least 4 years in each specified experience area, or a high school diploma with at least 6 years in each specified experience area.
Experience dealing with payers and government agencies regarding process issues that result in non-payment of beneficiaries’ medical charges.
Ability to manage small- to medium-sized projects, multitask on medium- to complex work assignments, and meet critical deadlines.
Ability to lead meetings, take minutes, track key decisions, prioritize deliverables, and maintain issue lists.
Ability to elicit information about the underlying needs of patients, the organization, and user communities to guide process or system changes.
Ability to perform business analysis and workflow documentation using tools such as Visio or equivalent workflow software.
Ability to troubleshoot and resolve problems, provide user support, create reports, and communicate with management.
Strong organization, attention to detail, communication, planning, follow-up, interpersonal, written, oral, and customer-service skills.
Proactive, team-oriented approach with critical-thinking and problem-solving abilities.
Confidence in complex business situations and ability to de-escalate sensitive patient calls.
Ability to present to large and small groups for community education.
Ability to communicate at all organizational levels and work across teams on Revenue Cycle issues.
High commitment and integrity; ability to maintain a positive attitude in a dynamic, fast-paced environment.
Knowledge of medical terminology, ICD-10, CPT-4, CDM codes, coding principles, and their application to billing.
Extensive knowledge of clinical business operating systems and knowledge of Snap, Web Denis, CHAMPS, and other payer sites.
In-depth knowledge of third-party payer rules, including Medicare, Medicaid, BCBSM, commercial, motor vehicle accident, and workers’ compensation payers.
Excellent attendance and punctuality.

Nice To Haves

Experience with vendor and customer relationship management.
Familiarity with diverse operating environments, applications, and equipment.
Experience with the Epic health information system.
Experience in medical accounts receivable and billing.
Experience and understanding of Michigan Medicine’s business systems that support Revenue Cycle.

Responsibilities

Perform patient financial advocacy, business analysis, process evaluation, design, and documentation, primarily to improve the patient financial experience.
Resolve escalated billing, financial counseling, and authorization issues; integrate solutions into best practices and de-escalate sensitive patient calls.
Manage complex financial care and processes for patients and families throughout their medical care at Michigan Medicine.
Monitor and proactively manage patients’ complex financial status, communicating with patients, families, attorneys, assistance programs, insurance companies, and other internal and external customers.
Work with leaders and organizations to serve Sparrow communities, including UMH Sparrow rural health clinics and programs.
Participate in UMH Sparrow-sponsored community events and organized outreach activities, including presentations and connections with underserved populations.
Educate communities about health insurance, plans, and networks and support increased Marketplace and Medicaid enrollment in the specified counties.
Build partnerships with standing community organizations and outreach programs.
Enroll patients in ACA and Medicaid plans and coordinate with DHHS workers on pending applications.
Educate and train staff on tools and resources supporting the financial success of the Pre-Service division.
Partner with vendors, payers, internal customers, and peer organizations to improve technology and process performance.
Collect and present KPI and metrics reporting and document community connections for nonprofit, government regulatory, or other outreach reporting.
Analyze business and user needs, document requirements, and address existing system or process difficulties.
Analyze, compare, and evaluate courses of action.
Apply systems analysis and consider the business implications of technology in the current business environment.
Perform other related duties and participate in other departmental projects as workload and needs permit.