Financial Advocate

Advocate Health; Park Ridge (IL); On-site; USD 40,000 - 60,000; Full time

Job summary

Advocate Health is seeking a Financial Counselor to determine patients' financial responsibility before services, explain insurance and cost sharing, and arrange payment plans. This role requires familiarity with Medicaid, charity care, and other assistance programs, along with strong HIPAA compliance.

The position involves travel as needed within the service area and collaboration with physicians and care teams to secure funding and clarify patient responsibilities.

Qualifications

• 2 years of experience in Patient Access, health care, insurance industry, or customer service
• Ability to explain HIPAA/EMTALA regulations in patient interactions
• Knowledge of insurances, billing, denials, and appeals

Responsibilities

• Communicates patient liability clearly and explains deductibles, coinsurance, and copayments
• Requests upfront payments and establishes payment arrangements
• Assists uninsured patients with applying for available programs and funding sources
• Collaborates with social workers and eligibility vendors to maximize Medicaid/assistance
• Educates on Financial Assistance Policy and related patient responsibilities
• Stays informed on government funding regulations (Medicare/Medicaid) and HIPAA compliance
• Performs duties with HIPAA-compliant handling of patient interviews and data
• Serves patients in various settings including virtual, clinic, and urgent care

Skills

Customer service

HIPAA/EMTALA knowledge

Medical coding basics

Insurance denials & appeals

Written communication

Education

High School Diploma

GED or HSED

Job description

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.