Patient Financial Advocates - Admitting - Full time 8 Hours Days (8:00am to 4:30pm) (Non-Exempt, Union)

University of Southern California

2d•Onsite

About The Position

The Patient Financial Advocate is responsible for providing patients with a positive financial experience by helping them navigate and understand insurance benefits and financial liability, including for unfunded patients. The role involves performing daily quality control on accounts, collecting monies due, advising patients in person and over the phone about their insurance benefits and coverage, and assessing patient referrals for appropriateness. The incumbent also assists patients with eligibility for government programs, MHSC’s Financial Assistance program, and other options for managing high medical liabilities. This position requires independent judgment and decision-making to address a full range of tasks and responsibilities. The Patient Financial Advocate must plan, schedule, and organize numerous tasks that directly impact hospital and physician reimbursement, while adhering to Methodist Hospital’s Mission, Vision, Values, and Performance Standards. They are expected to support co-workers, engage in positive interactions, and provide helpful assistance in anticipating and responding to customer needs.

Requirements

High School diploma or equivalent
1-year prior experience at a health insurance company, medical office or hospital.
Must be BLS certified or must provide BLS certificate within 30 days of hire.
M.A.B certification required. New hires must obtain within 6 months of hire.
Complete Certified Patient Access Course and Specialist Exam within 90 days of hire.

Nice To Haves

Associate degree preferred

Responsibilities

Be cross-trained and successfully able to work in all areas of Admitting as needed by the department.
Conducting phone and in person interviews, explaining hospital policies, obtaining treatment or billing consents and obtaining acknowledgements per type of Health Plan (Medicare forms, etc.).
Determine patient financial status and explain patient financial responsibility and patient rights.
Perform quality control on accounts, verifying accurate demographic and financial information, including reviewing and interpreting insurance benefits.
Ensure notification is made to the appropriate party to initiate admission authorization per plan guidelines, per plan eligibility.
Follow up and obtain approved authorizations for services rendered per plan guidelines.
Record and maintain complete detailed documentation of all activities and communication performed including financial arrangements on each account daily, in real time.
Monitor accounts daily/as needed to ensure all changes are captured and documented correctly including sending updated information per plan guidelines to ensure correct authorization for services rendered.
Responsible to maintain at least a 90% accurate rate of all accounts reviewed.
Identify potential third-party liability, including Workers’ Compensation, Commercial, COB Medicare and Medi-cal.
Screen patients for financial assistance, charity or other programs and assist with completing forms and obtaining necessary documentation.
Calculate and collect cash payments when appropriate, including cash deposits for uninsured patients and letter or agreements.
Notify appropriate staff (Care Coordination, Social Services, Admitting, etc.) of cases screening determinations and outcomes, including insurance eligibility, limitations and capitations.
Work as a liaison with DPSS LA county Medi-Cal representatives in screening and completing State/County Medi-Cal forms, including temporary Medi-Cal applications.
Schedule and confirm appointments for patients or responsible party to discuss applications and documentation needed per county guidelines.
Discuss outstanding balances with patients that are receiving current services and work closely with customer service on creating payment plans to resolve older debt.
Participate in data gathering for financial reporting.
Follow safety procedures, operate equipment and perform job-related duties in a safe manner including reporting unsafe conditions/situations.
Remain informed and compliant with HIPAA, EMTALA, the Fair Debt and Collection Practices Act, and other laws and regulations that govern Patient Financial Services.
Remain informed regarding all HMO, PPO, Medicare, Medi-Cal and indigent service programs and requirements for timely processing of claims.
Perform various other duties, as assigned/needed by the organization.