Patient Financial Advocate

Brown Medicine•Pawtucket, RI

14d•$21 - $35•Onsite

About The Position

Under general supervision and within established hospital and departmental policies and procedures, the Patient Financial Advocate serves as a liaison between Brown University Health Rheumatology, patients, and family members. The role determines patients’ portions of medical expenses and identifies, develops, and secures resources that may help patients and families resolve medical expenses. The advocate obtains and verifies coverage authorizations for referrals, medications, and procedures, confirms financial clearance from insurance companies, and coordinates the insurance denial process. The role advocates for patients and families in resolving outstanding accounts, negotiates payment conditions and plans, and advises patients about available payment resources. It also supports applications and appeals for public assistance, verifies insurance coverage and eligibility, obtains authorizations, determines expected insurance benefits and patient payments, and coordinates responses to denied services. The advocate works with providers, payers, and Brown University Health personnel to resolve authorization, billing, and denial issues, and may assist with patient registration, appointment scheduling, and document handling. Employees are expected to model Brown University Health’s values of Compassion, Accountability, Respect, and Excellence and demonstrate the Success Factors of Instill Trust and Value Differences, Patient and Community Focus, and Collaborate. The position performs independently within departmental policies and refers complex matters to a supervisor when clarification is needed.

Requirements

Knowledge of third-party coverage, prior authorization processes, and referrals.
Current knowledge of state and federal resources for people who are needy or disabled, including forms and documents required to appeal denied claims.
Interpersonal skills to communicate effectively with patients, family members, Brown University Health employees, third-party payers, state and federal representatives, and government service agencies.
Ability to use a computer to access information and prepare and maintain records and reports.
Strong medical terminology knowledge and clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and registration information.
Strong organizational skills to plan, direct, and manage a high volume of orders requiring prior authorization.
Analytical skills to evaluate workflow effectiveness, recommend changes, and develop, review, and evaluate records and reports.
Two years of progressively responsible health care experience, with substantial emphasis in one or more of these areas: patient care environment, health care operations, database management, prior authorizations, referrals, documentation, or departmental operations.
Excellent analytical and critical-thinking skills and attention to detail.
Ability to sit for long periods at a workstation using a computer and telephone; light walking may be required; ability to lift up to ten pounds.

Nice To Haves

Knowledge of coding in a health care environment.

Responsibilities

Advocate for patients, families, and surrogates in resolving outstanding patient accounts.
Arrange and negotiate payment conditions and plans and counsel patients about available payment resources.
Interview patients and family members about financial and dependency status and other factors relevant to medical assistance or state and federal program eligibility.
Secure legal counsel and aid for patients and families.
Help patients obtain documentation required to apply for public assistance and assist with fair-hearing appeals when assistance is denied.
Maintain current files, records, and documentation concerning state and federal programs and regulations.
Verify primary and secondary patient insurance coverage online or by telephone.
Obtain and verify coverage authorizations for scheduled and unscheduled patients, including applicable workers’ compensation, Medicare Secondary Payer, Medicare liability, and lien sources.
Establish insurance benefit levels and expected payments for selected services; determine and communicate the patient’s portion when applicable.
Ensure referrals are obtained and verify the accuracy of the primary care physician information.
Review reports and records to ensure referrals and pre-authorizations have been received.
Confirm patient eligibility with insurance carriers and obtain visit authorizations as needed.
Contact third-party payers to obtain pre-authorizations in accordance with established policies.
Coordinate peer-to-peer discussions between physicians or mid-level providers and insurers to seek prior authorization for denied services.
Coordinate information needed to manage insurance denials.
Collaborate with Brown University Health personnel to resolve billing issues, prior authorizations, denials, and insurance denial write-offs.
Participate in business team meetings and recommend solutions to perceived problems.
Perform other duties supporting department operations, including patient registration, appointment scheduling, scanning, and faxing.
Refer complex problems to a supervisor when clarification of departmental policies or procedures is required.