Pre-arrival Financial Advocate

Advocate Health and Hospitals Corporation • Charlotte, NC

4d • Remote

About The Position

The Pre-arrival Financial Advocate is responsible for calculating and providing patients with personalized estimates of their financial responsibility prior to service. This role involves clearly and accurately communicating patient liability, explaining concepts like deductibles and coinsurance, and detailing how non-covered and out-of-network services affect out-of-pocket costs. The advocate will also request upfront payments for self-pay amounts and outstanding balances, establish payment arrangements, and interview uninsured patients to assess financial needs and identify assistance programs. They will coordinate with patients to complete necessary paperwork, follow up to secure funding sources, and initiate credit scoring to determine eligibility for programs like Medicaid and hospital-sponsored charity care. Collaboration with state social workers or external vendors is key to assisting with Medicaid applications. The role requires a strong understanding of insurance benefits, Marketplace options, and payer sources, as well as educating offices and patients on applicable organizational policies. Coordination with provider offices to align scheduling with funding needs and clarification of financial responsibility is also a part of this position. Staying current on regulations for government funding, particularly Medicare and Medicaid, and adhering to internal charity care policies and federal regulations like 501R are essential. The position must be performed in a HIPAA-compliant manner, managing demographic data and interactions effectively. Collaboration with peers is expected to ensure a smooth operational flow for uninsured patients or those concerned about upcoming service costs. The advocate will serve consumers in various settings, including virtual, bedside, Emergency Department, clinic exam rooms, Urgent Care, consult spaces, or a Financial Resource Specialist office.

Requirements

• Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting.
• Ability to communicate clearly and proactively to management about issues involving customer service and process improvement opportunities.
• Ability to articulate explanations of HIPAA and EMTALA regulations as they relate to all patient interactions within the operational flow involving the Financial Advocate, either virtually or in person.
• Has solid knowledge of how various types of insurances operate related to denials and appeals processes.
• Basic medical coding knowledge.
• Understanding of insurances, billing and denials
• Ability to use a combination of scripted notes and clear, written communication when documenting in patients’ accounts.

Nice To Haves

• None Required.

Responsibilities

• Calculates and provides patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service.
• Communicates patient liability clearly and accurately while adequately explaining concepts such as deductibles, coinsurance, and/or copayments and how they may affect the cost of care.
• Explains how non-covered and out-of-network services factor into the out-of-pocket cost.
• Requests upfront payment toward self-pay amounts, including estimated out-of-pocket costs and outstanding previous balances.
• Establishes payment arrangements in advance of scheduled services when applicable, communicating due dates and the amount of each installment.
• Interviews uninsured patients to assess for qualifying financial needs.
• Identifies available assistance programs and coordinates with patient to complete paperwork and applications for any potential coverage(s).
• Continues follow-up efforts to obtain a funding source for patient’s health services.
• Initiates credit scoring to determine each patient’s eligibility for Medicaid, hospital-sponsored charity care, and other programs through a comprehensive patient interview.
• Works in conjunction with state social worker and/or outside eligibility vendor to assist in the appropriate completion of Medicaid applications, ensuring this funding source is maximized based on patients’ eligibility.
• Demonstrates working knowledge of insurance benefits, insurance companies, and Marketplace insurance options, and stays informed of other payer sources entering the markets.
• Educates physician office/patient on the organization’s applicable policies such as Financial Assistance Policy, Patient Financial Responsibility, Non-Covered Services, and Deferral of Care.
• Coordinates with provider office to determine scheduling options based on the need to secure funding and clarify patient’s financial responsibility.
• Stays current on regulations and eligibility requirements for government funding, especially Medicare and Medicaid.
• Understands and complies with all internal charity care policies and processes.
• Understands, complies with, and can articulate federal regulations around 501R.
• Performs in a HIPAA-compliant manner with all pertinent patient interviews, including management of demographic data, topics discussed, and actions taken.
• Collaborates with peers in the operational flow for uninsured patients or patients that are concerned about costs for upcoming services.
• Serves consumers in various settings, including virtual, bedside, Emergency Department room, clinic exam room, Urgent Care, consult space, or a Financial Resource Specialist office.

Benefits

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program

What This Job Offers

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