Patient Financial Navigator

Avera Health•Sioux Center, IA

33d•Onsite

About The Position

The Patient Financial Navigator is responsible for making financial arrangements for patients in a variety of financial and insurance positions; collects deposits prior to service when applicable; and assists in obtaining financing for services. This position must have a basic understanding of government programs and screens and refers patients when applicable. Provides charity applications as requested or deemed appropriate for the patient. Responsible for ensuring insurance eligibility, benefit verification and patient estimates. Understand and interpret patient liability and benefits for all payer types including copays, co-insurance, and out-of-pocket responsibilities to provide patients and families with information on their financial responsibility.

Requirements

High school diploma or GED; or one to three months related experience and/or training; or equivalent combination of education and experience.

Nice To Haves

One or two year college level education preferred.
One to three years prior hospital-based Business Office operation experience preferred.
Bi-lingual experience preferred but not required.

Responsibilities

Pre-Visit Financial Counseling and Insurance Verification:
Verify patient demographics, insurance coverage, mnemonics, and benefits prior to scheduled services. Work with Patient Access team to resolve discrepancies or missing information.
Confirm medical necessity, prior authorizations, eligibility, and physician orders are in place.
Ensure accurate pre-registration and timely communication of information with clinical and billing teams.
Screen (pre-call) scheduled non-urgent patients (in and outpatient) patients prior to service, collect minimum payment prior to surgery and assure plan for financial coverage is in place before service is performed.
Educate patients on their rights and responsibilities regarding healthcare costs.
Provide clear personalized cost estimates of charges and out-of-pocket costs for procedures, treatments, or services.
Identify potential coverage issues and work to resolve issues before service.
Review with patients prior to or at time of care to explain estimated costs, insurance coverage, and potential out-of-pocket expenses.
Screens self-pay patients for potential payer coverage.
Assist uninsured or underinsured patients with insurance enrollment or alternative coverage options (e.g., Medicaid, Marketplace plans).
Educate patients on available financial assistance, payment plans and charity care programs.
Identifies all payment sources for accurate primary and secondary payer coverage to prevent denials and/or reduction in payment.
Financial Counseling and Patient Navigation:
Serve as a point of contact for patients with billing or payment concerns, ensuring timely resolution and excellent customer service.
Assist patients in understanding billing statements and breaking down charges.
Educate patients about insurance benefits, copays, deductibles, and coinsurance responsibilities.
Set up and manage patient payment plans, including alternative options such as third-party loans, and monitor adherence.
Serve as the primary contact for patients seeking financial assistance, charity care, or coverage through state and federal programs (e.g., IA Medicaid).
Provide guidance, prepare documentation, and process charity care applications while ensuring alternative account resolution methods are in place.
Understand and communicate processing time frames and requirements for Medicaid, County, Federal Disability, and other programs available to patients.
Process and track all Medicaid, 3-Day Emergency Medicaid, and Presumptive Medicaid applications turned in from Social Services and Interpretive Services using the Medicaid Pending mnemonic and entering the Medicaid ID or changing to payer to self-pay when approved or denied
Collaborate with the clinical staff, and social services to address financial barriers impacting care.
Accurately document all financial counseling interactions in the electronic medical record (EMR) or billing system. billing department to ensure accurate and timely billing.
Ensure that financial considerations do not delay or prevent necessary medical treatment.
Performs other duties and responsibilities as assigned.