UMH Sparrow - PATIENT FINANCIAL ADVOCATE

Sparrow•Lansing, MI

26d•Onsite

About The Position

Under the general supervision of the Director Patient Access, the Patient Financial Advocate defines and implements best practices to support patients experiencing unexpected financial obligations or loss of insurance coverage. The role uses fact-finding, data analysis, case reviews, auditing, gap analysis, and industry best practices to streamline work and close identified gaps. The advocate communicates solutions, issues, and risks to management and other responsible entities to support integrated solutions across work streams. The position provides patient financial advocacy, business analysis, process evaluation, design, and documentation, primarily to improve the patient financial experience. It handles complex escalated billing, financial counseling, and authorization issues; supports patients and families with ongoing complex financial needs; and manages patients’ financial status throughout their medical care. The role works with patients, families, attorneys, assistance programs, insurers, vendors, payers, internal customers, and peer organizations. The advocate also supports Sparrow communities and rural health clinics through community outreach, education, and participation in sponsored events. Responsibilities include educating people about insurance plans and networks, supporting Marketplace and Medicaid enrollment, working with DHHS staff on pending applications, and building partnerships with community organizations. The role provides staff education and training, participates in KPI and metrics reporting, analyzes business and user needs, documents requirements, evaluates alternatives, and considers the business implications of technology. Other related duties and departmental projects may be assigned based on workload and needs.

Requirements

Bachelor’s degree in Business Administration, Health Care Administration, or a related field, plus at least 2 years as a patient financial counselor assisting patients with complex medical billing issues and at least 2 years of billing and/or claims experience in a Revenue Cycle or healthcare setting with progressive responsibility, or completion of an accredited billing and claims processing program; OR an associate degree in business or a related field with the corresponding patient counseling and billing/claims experience of at least 4 years; OR a high school diploma with the corresponding experience of at least 6 years.
Experience dealing with payers and government agencies on process issues that result in non-payment of beneficiaries’ medical charges.
Ability to manage small and medium projects, multitask on medium to complex assignments, and meet critical deadlines.
Ability to lead meetings, take minutes, track key decisions, prioritize deliverables, and maintain issue lists.
Ability to probe for underlying needs of patients, the organization, and user communities to inform process or system changes.
Ability to perform business analysis and workflow documentation using Visio or equivalent workflow software.
Ability to troubleshoot and resolve problems, provide user support, create reports, and communicate with management.
Strong organization, attention to detail, communication, planning, and follow-up skills.
Proactive, team-oriented work style with critical-thinking and problem-solving abilities.
Excellent interpersonal, written, oral communication, organizational, and customer-service skills; professional image; confidence in complex business situations; and ability to de-escalate sensitive patient calls.
Ability to present to large and small groups to promote community education.
Ability to communicate effectively at all organizational levels and work across teams on Revenue Cycle issues.
High commitment and integrity, and ability to maintain a positive attitude in a dynamic, fast-paced environment.
Knowledge of medical terminology, ICD-10, CPT-4, CDM codes, coding principles, and their application to billing.
Extensive knowledge of clinical business operation systems and knowledge of Snap, Web Denis, CHAMPS, and other payer sites.
In-depth knowledge of third-party payer rules, including Medicare, Medicaid, BCBSM, commercial insurance, motor vehicle accident, and workers’ compensation.
Excellent attendance and punctuality.

Nice To Haves

Experience with vendor and customer relationship management.
Familiarity with diverse operating environments, applications, and equipment.
Experience with the Epic health information system.
Experience in medical accounts receivable and billing.
Experience with Michigan Medicine’s multiple business systems that drive Revenue Cycle.

Responsibilities

Perform patient financial advocacy, business analysis, process evaluation, design, and documentation to support an improved patient financial experience.
Resolve escalated billing, financial counseling, and authorization issues, de-escalating sensitive patient calls and incorporating solutions into best practices.
Provide ongoing financial care for patients and families with complex needs throughout their medical care at Michigan Medicine.
Monitor and proactively manage the financial status of patients with complex financial circumstances, coordinating with patients, families, attorneys, assistance programs, and insurers.
Work with leaders and organizations to serve Sparrow communities, including UMH Sparrow rural health clinics and programs.
Participate in UMH Sparrow-sponsored community events.
Educate communities in the listed counties about health insurance, plans, and networks, and support increased Marketplace and Medicaid enrollment.
Conduct community outreach through events and presentations and connect with underserved populations.
Serve on community organizations and outreach programs to establish mutually beneficial partnerships.
Enroll patients in ACA and Medicaid plans and work with DHHS workers on pending applications.
Provide staff education and training on tools and resources supporting the financial success of the Pre-Service division.
Partner with vendors, payers, internal customers, and peer organizations to improve technology and process performance.
Collect and present KPI and metrics reporting and document community connections for nonprofit, government regulatory, or other outreach reporting.
Analyze business and user needs, document requirements, and address existing system or process difficulties.
Analyze, compare, and evaluate courses of action.
Consider the business implications of applying technology in the current business environment.
Perform other related duties and departmental projects as assigned based on workload and needs.