Financial Advocate

sanford; Sioux Falls (SD); On-site; USD 27,000 - 42,000; Full time

Job summary

Sanford Health in Sioux Falls, SD seeks a dedicated Patient Financial Advocate to help patients navigate insurance coverage, treatment costs, and financial hardship programs.

You will screen self-pay patients, determine eligibility for programs, discuss payment plans, and coordinate with departments to ensure accurate and timely assistance. This is a full-time, on-site role requiring strong communication and attention to detail.

Qualifications

• Bachelor's degree in social work, case management, public relations or related field.
• In lieu of degree, six years equivalent work experience.

Responsibilities

• Screen self-pay patients and evaluate eligibility for governmental and non-governmental programs to ensure patients are assisted in meeting their financial obligations.
• Discuss agreeable payment plans with qualified patients.
• Identify all sources of potential payers including Commercial Insurance, Private Insurance, etc.
• Provide and complete the Financial Assistance Application form and assist patients in applying for benefits.
• Determine patient eligibility for assistance programs through interviews and screening processes.
• Complete an insurance benefit investigation for new/transferring patients as appropriate.
• Complete prior authorization as necessary.
• Work with patients to ensure continued eligibility and re-certifications.
• Contact appropriate agencies to obtain information and paperwork for assistance.
• Educate patients on sponsorship programs including Medicare, Medicaid, SSI, and other programs.

Skills

Financial counseling

Communication

Interpersonal skills

Education

Bachelor's degree

Job description

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland.

Work Shift

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours

40

Compensation

Salary Range: $19.25 - $30.50

Union Position

No

Department Details

Summary

Provides financial advocacy counseling to patients/families including topics of insurance coverage, treatment coverage, prompt pay and financial hardship discounts to patients and family members.

Job Description

• Responsible for screening self-pay patients and evaluate them to determine eligibility in various governmental and non-governmental programs to ensure patients are assisted in meeting their financial obligations.
• Discuss agreeable payment plans with qualified patients.
• Responsible for identifying all sources of potential payers including Commercial Insurance, Private Insurance, etc.
• Also responsible for providing and completing the Financial Assistance Application form and assisting patients in the process of applying for any benefits for which they may be eligible.
• Determine patient eligibility for assistance programs through interviews and screening processes.
• Complete an insurance benefit investigation for all new/transferring patients as appropriate.
• Completes prior authorization as necessary.
• Works with patients to ensure continued eligibility and ensure re-certifications.
• Contacts appropriate agencies to obtain information and paperwork necessary to process patient's assistance applications.
• These resources can include state caseworkers, banks, employers, Social Security Administration, medical facilities, and insurance companies.
• Assist with patient assistance programs offered by pharmaceutical companies, state governments and nonprofit groups.
• Educates patients on various sponsorship programs available based on eligibility including but not limited to Medicare, Supplemental Security Income, Social Security Disability, Medicaid programs, County eligibility, and Indian Health Services.
• Assist with completing FMLA and Disability paperwork requirements.
• Assist patients to navigate the Medicare System to ensure benefit start dates are accurate, correct insurance is primary, ESRD benefits, etc.
• Ensures avenues of reimbursement or assistance are pursued for uninsured and underinsured patients.
• Refers patients to other agencies for assistance when needed and discusses the financial statement process relating to payment options and hospital assistance, including grants.
• Follows up in obtaining missing insurance information, patient demographics, etc., on patient accounts for the proper handling in the billing office.
• Complete price estimates.
• Completes annual review of insurance pamphlet and coverage options as mandated by Conditions for Coverage.
• Communicates with supervisor and various departments such as Nursing, Physicians, Case Management, Social Work, Patient Access, Patient Relations, Quality Resource Management and Social Services to address patient concerns.
• Complies with other job-related responsibilities as directed by Leadership.
• Demonstrates a caring and respectful attitude to all patients, family members, visitors and fellow employees as defined in the mission and values of the organization.

Qualifications

• Bachelor's degree in social work, case management, public relations or related field required.
• In lieu of degree, consideration may be given to six years equivalent work experience.

Sanford is an EEO/AA Employer M/F/Disability/Vet.