Patient Financial Advocates - Admitting - Full time 8 Hours Days (8:00am to 4:30pm) (Non-Exempt, Non-Union)
About The Position
The Patient Financial Advocate provides patients with a positive financial experience by helping them understand insurance benefits, financial liability, and available options, including for patients without funding. The role performs daily account quality control, collects amounts due, and advises patients in person and over the phone about insurance benefits and coverage. It may also assess patient referrals for appropriateness. The advocate helps patients determine eligibility for government programs, MHSC’s Financial Assistance program, and other ways to manage high medical liabilities. The position requires independent judgment and decision-making, as well as the ability to plan, schedule, and organize tasks that affect hospital and physician reimbursement. The advocate is expected to uphold Methodist Hospital’s mission, vision, values, and performance standards, support coworkers, and respond helpfully to customer needs. The role is full-time, scheduled for an eight-hour day shift from 8:00 a.m. to 4:30 p.m., and is classified as non-exempt and non-union. The hourly salary range is $21.00–$24.97.
Requirements
- High school diploma or equivalent.
- At least one year of prior experience at a health insurance company, medical office, or hospital.
- BLS certification, or provide a BLS certificate within 30 days of hire.
- M.A.B. certification; new hires must obtain it within six months of hire.
- Complete the Certified Patient Access Course and Specialist Exam within 90 days of hire.
Nice To Haves
- Associate degree preferred.
Responsibilities
- Cross-train and work in all areas of Admitting as needed.
- Conduct phone and in-person interviews; explain hospital policies; and obtain treatment or billing consents and acknowledgements required for the patient’s health plan.
- Determine patients’ financial status and explain their financial responsibility and rights.
- Perform account quality control by verifying demographic and financial information and reviewing and interpreting insurance benefits.
- Notify the appropriate party to initiate admission authorization in accordance with plan guidelines and eligibility.
- Follow up to obtain approved authorizations for services rendered according to plan guidelines.
- Maintain complete, detailed, real-time documentation of activities, communications, and financial arrangements for each account.
- Monitor accounts and capture and document changes, sending updated information as required to ensure correct service authorization.
- Maintain an accuracy rate of at least 90% for accounts reviewed.
- Identify potential third-party liability, including Workers’ Compensation, commercial insurance, COB Medicare, and Medi-Cal.
- Screen patients for financial assistance, charity, or other programs; help complete forms and obtain supporting documentation.
- Calculate and collect cash payments when appropriate, including uninsured patient deposits and payments under letters or agreements.
- Notify appropriate staff, including Care Coordination, Social Services, and Admitting, of screening determinations and outcomes, including insurance eligibility, limitations, and capitations.
- Liaise with Los Angeles County DPSS Medi-Cal representatives to screen and complete State and County Medi-Cal forms, including temporary Medi-Cal applications; schedule and confirm appointments to discuss applications and required documentation.
- Discuss outstanding balances with patients receiving current services and work with customer service to create payment plans for older debt.
- Participate in gathering data for financial reporting.
- Follow safety procedures, operate equipment, perform job duties safely, and report unsafe conditions or situations.
- Stay informed about and comply with HIPAA, EMTALA, the Fair Debt and Collection Practices Act, and other laws and regulations governing Patient Financial Services.
- Stay informed about HMO, PPO, Medicare, Medi-Cal, and indigent service programs and requirements for timely claims processing.
- Perform other duties as assigned or needed by the organization.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
