Financial Advocate

American Addiction Centers; Two Rivers (WI); On-site; USD 30,000 - 47,000; Full time

Benefits offered by this job

Health benefits

Paid time off

Educational assistance

Job summary

Advocate Health in Wisconsin is seeking a Financial Advocate for the Revenue Cycle - Eligibility team. This onsite, full-time role supports patients with upfront financial estimates, payment arrangements, and insurance-based funding options.

The ideal candidate will have a high school diploma or GED/HSED, about 2 years in patient access or related fields, and strong communication and regulatory knowledge to explain costs and assist with Medicaid and charity programs.

Qualifications

• Ability to communicate clearly with management about customer service and process improvement.
• Knowledge of HIPAA and EMTALA as they relate to patient interactions in financial advocacy.
• Solid understanding of how insurances operate regarding denials and appeals processes.

Responsibilities

• Calculates and provides patients with personalized estimates of their financial responsibility based on insurance prior to service.
• Explains patient liability including deductibles, coinsurance, and copayments and how out-of-network charges affect costs.
• Requests upfront payment toward self-pay amounts and establishes payment arrangements in advance of services.
• Interviews uninsured patients to assess financial needs and coordinates with applicants for coverage or funding sources.
• Assists in Medicaid applications and coordinates with state social workers or vendors to maximize funding.

Skills

Communication

HIPAA knowledge

Insurance basics

Medical coding

Customer service

Education

High School Diploma

GED/HSED

Job description

Department:

10330 Enterprise Revenue Cycle - Eligibility: Wisconsin

Status:

Full time

Benefits Eligible:

Yes

Hours per Week:

40

Schedule Details/Additional Information:

Onsite. Mon-Fri 8:00am-4:30pm.

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.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate’s job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, andShort- 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

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.; please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.