Financial Advocate

Aurora Health Care; Milwaukee (WI); On-site; USD 45,000 - 70,000; Full time

Job summary

Aurora Health Care seeks a Financial Advocate to estimate patient financial responsibility and communicate about deductibles, coinsurance, and copays prior to service.

The role interviews uninsured patients, coordinates with programs for coverage, and ensures accurate submission of paperwork for potential funding, while maintaining HIPAA compliance across all interviews and records.

Qualifications

• Ability to communicate clearly and proactively with management about issues involving customer service and process improvement opportunities.
• Ability to articulate HIPAA and EMTALA regulations as they relate to patient interactions in the Financial Advocate role.
• Solid knowledge of how insurances operate related to denials and appeals processes.
• Basic medical coding knowledge.
• Understanding of insurances, billing and denials.
• Ability to document in patients’ accounts using scripted notes and clear written communication.

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 explaining deductibles, coinsurance, and/or copayments; clarifies non-covered and out-of-network costs.
• Requests upfront payment toward self-pay amounts and establishes payment arrangements with due dates and installments.
• Interviews uninsured patients to assess financial needs, identifies assistance programs, and coordinates with patients to complete paperwork for coverage.
• Initiates credit scoring to determine Medicaid, charity care, and other programs eligibility via patient interview.
• Collaborates with social workers or eligibility vendors to maximize Medicaid funding based on eligibility.
• Educates patients and physician offices on policies such as Financial Assistance Policy and Deferral of Care; coordinates scheduling options to secure funding.
• Keeps current on funding regulations for Medicare/Medicaid and internal charity policies; understands 501R regulations; maintains HIPAA-compliant records.
• Collaborates across departments to assist uninsured patients or those concerned about costs across multiple care settings.

Skills

Clear communication

HIPAA & EMTALA knowledge

Insurance denials/appeals

Medical coding knowledge

Billing & collection understanding

Documentation accuracy

Education

High School Diploma

GED/HSED

Job description

• 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.

Major 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.

Licensure, Registration, And/or Certification Required

• None Required.

Education Required

• High School Graduate, or


• Certificate of General Educational Development (GED) or High School Equivalency Diploma (HSED).
  

Experience Required

• Typically requires 2 years of experience in Patient Access, health care, insurance industry, or in a customer service setting.
  

Knowledge, Skills & Abilities Required

• 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.
  

Physical Requirements And Working Conditions

• This position requires travel, therefore, will be exposed to weather and road conditions.


• Operates all equipment necessary to perform the job.


• Exposed to a normal office environment.


• Must be able to sit a majority of the workday


• Occasionally lift up to 10 lbs.
  

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.