Patient Financial Advocate

Presbyterian System Services • Albuquerque, WY

1d • Onsite

About The Position

The Patient Financial Advocate performs financial screening of hospital and medical group account activity to identify residual balances, high-deductible plan participants, and self-pay patients. The role requires knowledge of assistance programs, including Community Benefit and Medicaid (PEMOSSA) applications where applicable, other alternate resource programs, and Presbyterian payment-plan policies. The advocate researches disputed balances, resolves accounts with outstanding residual balances, and understands benefits administration and in- and out-of-network arrangements for PHS contracts. They use knowledge of pre-billing and pre-adjudication processes to identify patients’ out-of-pocket expenses and counsel patients and families about financial responsibilities. Chronic no-pay or bad-debt accounts are escalated to a supervisor. Uninsured patients are referred to the Financial Advocacy Center for help navigating options, including Marketplace coverage.

The advocate supports patients and families through financial education, accurate registration, payment collection, and account documentation. They use established patient-experience practices, respond to concerns and distress, follow clinic safety and cash-handling procedures, and assist the clinic team as directed. The position is full-time, non-exempt, based at PMG - Wyoming in Albuquerque, New Mexico, and works day shifts.

Requirements

• High school diploma or equivalent.
• Three to five years of healthcare experience in a physician office or hospital setting.
• Demonstrated commitment to Presbyterian’s Sense of Mission by role-modeling CARES behaviors and appropriate customer-service techniques, educating patients, and serving as a patient and member resource and advocate.
• Detailed knowledge of medical-practice operations, including what work is done, how it is done, and why.
• Familiarity with the Affordable Care Act and healthcare’s role in helping patients and families manage healthcare costs.
• Ability to interpret data.
• Understanding of billing methodology for an integrated delivery system, including laboratory and other ancillary services.
• Must be at least 18 years of age at the time of hire.

Nice To Haves

• Prior billing-office and collection experience.
• Significant provider and patient interaction experience.

Responsibilities

• Perform financial screening of hospital and medical group accounts to identify residual balances, high-deductible plan participants, and self-pay patients.
• Research disputed account balances and resolve accounts with outstanding residual balances.
• Counsel patients and families about financial responsibilities and expected out-of-pocket expenses, including copayments, coinsurance, deductibles, and residual balances.
• Use workflow to update the DAR (Epic Department Appointment Report) so registration staff are alerted to residual amounts for appointed patients.
• Set payment expectations during patient interactions and establish payment plans in Epic according to guidelines.
• Maintain exceptional registration accuracy, including identifying and correcting errors and ensuring correct coordination of benefits.
• Serve as a resource to staff regarding account interpretations.
• Identify claims with filing errors and resubmit them to payors for consideration.
• Collect identified patient financial obligations, including residual balances when applicable.
• Refer patients, as appropriate, to an on-site Financial Advocate or refer uninsured patients to the Financial Advocacy Center.
• Follow PMG cash-handling policies and balance daily.
• Stay current on PHS financial policies, payment plans, programs, and other funding options.
• Document patient discussions, agreed-upon outcomes, and audit-trail notes in guarantor account notes or the authorization/certification screen, as applicable.
• Use CARES, AIDET, and EPE tools to support an exceptional patient and family experience; address and attempt to resolve complaints, manage conflict, and seek supervisor assistance when appropriate.
• Respond promptly to patients showing distress, alert the clinical team according to clinic manager guidelines, and assist the clinic team as directed.
• Keep registration areas, waiting areas, and walkways clear, clean, and neat, and report potential safety concerns.
• Complete annual clerical staff competency requirements during a Code Blue.
• Escalate chronic no-pay or bad-debt accounts to a supervisor.

Benefits

• Medical, dental, and vision coverage.
• Short-term and long-term disability insurance.
• Group term life insurance and other optional voluntary benefits.
• Employee Wellness rewards program, with opportunities to earn gift cards by participating in wellness activities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED