Patient Financial Advocate

Brown Medicine•Providence, RI

6d•$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 Cancer Institute, 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 position obtains and verifies coverage authorizations for referrals, medications, and procedures, ensures insurance financial clearance, and coordinates the insurance denial process. The advocate represents Brown University Health’s values of Compassion, Accountability, Respect, and Excellence, and demonstrates its core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate. The role works independently within departmental policies and practices, referring complex problems to a supervisor when clarification is needed. There is no supervisory responsibility.

Requirements

Knowledge of third-party coverage, prior authorization processes, and referrals.
Current knowledge of state and federal resources available to people in need and people with disabilities, including familiarity with 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 related 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 assess workflow effectiveness, recommend changes, and develop, review, and evaluate records and reports.
At least two years of progressively responsible healthcare experience, with a heavy emphasis in one or more of the following: patient care environment, healthcare 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, walk lightly as needed, and lift up to ten pounds.

Nice To Haves

Knowledge of coding in a healthcare environment.

Responsibilities

Advocate for patients, families, and surrogates in resolving outstanding patient accounts.
Arrange and negotiate payment conditions and plans, and advise patients about resources available to pay medical expenses.
Interview patients and family members about financial and dependency status and other factors that may support eligibility for medical assistance or state and federal programs.
Secure legal counsel and aid for patients and families, and assist patients in obtaining documentation for public assistance applications.
Maintain current files, records, and documentation related to 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 Worker’s Compensation, Medicare Secondary Payer, Medicare liability, and liens.
Establish insurance benefit levels and expected payments for selected services; determine and communicate the patient’s portion of payment when applicable.
Review reports and records to ensure insurance 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 obtain prior authorization for denied services.
Coordinate information for managing insurance denials.
Collaborate with Brown University Health personnel to resolve billing issues, prior authorizations, denials, and insurance denials or write-offs.
Participate in business team meetings and recommend solutions to perceived problems.
Perform other departmental support duties as required, including patient registration, appointment scheduling, and scanning and faxing documents.