Financial Advocate

aah; Park Ridge (IL); Sur place; USD 32 000 - 47 000; Plein temps

Résumé du poste

aah is seeking an onsite teammate to help uninsured patients apply for Medicaid, meeting patients across the hospital and collaborating with care management to facilitate applications. The role focuses on calculating patient financial responsibility and guiding patients through Medicaid and charity options.

Qualifications include a high school diploma and 2 years of related experience in patient access, healthcare, or customer service.

Qualifications

• Clear and proactive communication with management about customer service and process improvement opportunities.
• HIPAA and EMTALA regulations explained in patient interactions.
• Understanding insurance operations related to denials and appeals.
• Basic medical coding knowledge.
• Knowledge of insurance, billing and denials.

Responsabilités

• Calculates and provides patients with personalized estimates of their financial responsibility based on their insurance coverage prior to service.
• Communicates patient liability clearly, explaining 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.

Connaissances

Clear communication

HIPAA/EMTALA knowledge

Insurance denials & appeals

Medical coding knowledge

Billing and denials understanding

Documentation skills

Formation

High School Diploma or GED

Description du poste

Department: 10339 Enterprise Revenue Cycle - Enrollment: Midwest

Status: Full time

Benefits Eligible: Yes

Hou rs Per Week: 40

Schedule Details/Additional Information: This is an onsite position focused on helping uninsured patients apply for Medicaid. The teammates will meet patient throughout the hospital, including in patients' room, the emergency rooms, and other departments where application assistance is needed. The teammate will also work with the care management team to help facilitate Medicaid applications.

The schedule is Monday through Friday, either 8:00 a.m.- 4:30 p.m. or 8:30 a.m.- 5:00 p.m. ONSITE

Pay Range: $22.90 - $34.35

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.