Patient Financial Advocate

Brown Health Medical Group•Pawtucket, RI

13d•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 resolve those expenses. The advocate obtains and verifies coverage authorizations for referrals, medications, and procedures, secures insurance financial clearance, and coordinates insurance denials. Employees are expected to model the organization’s values of Compassion, Accountability, Respect, and Excellence and demonstrate its core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate. The position works independently within departmental policies and practices, referring complex matters to a supervisor when clarification is needed. It has no supervisory responsibility. The role is based at 407 East Avenue in Pawtucket, Rhode Island, with a day schedule listed as Monday through Wednesday, 8 a.m. to 5 p.m., and eight daily hours.

Requirements

Knowledge of third-party coverage, prior authorization processes, and referrals.
Current knowledge of state and federal resources available to needy and disabled individuals, including forms and documentation for appeals of denied claims.
Interpersonal skills to communicate effectively with patients, family members, Brown University Health employees, third-party payers, and state and federal representatives and other 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 evaluate workflow effectiveness, recommend changes, and develop, review, and evaluate records and reports.
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; may need to walk lightly 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; negotiate payment conditions and plans and advise patients about available payment resources.
Interview patients and family members about financial and dependency status and other factors relevant to eligibility for medical assistance or state and federal programs.
Secure legal counsel and aid for patients and families, assist with documentation for public assistance applications, and support fair-hearing appeals when assistance is denied.
Maintain current files and documentation concerning state and federal programs and regulations.
Verify primary and secondary 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.
Determine insurance benefit levels and expected payment for selected services; determine and communicate patients’ payment portions when applicable.
Ensure referrals are obtained and confirm the accuracy of the Primary Care Physician (PCP).
Review reports and records to ensure referrals and insurance 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 services denied by insurance.
Coordinate information related to 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 make recommendations about perceived problems.
Perform other departmental operational duties, including patient registration, appointment scheduling, and scanning and faxing documents.