Financial Advocate GCM

Advocate Health; Albemarle (NC); On-site; USD 45,000 - 65,000; Full time

Job summary

Advocate Health in Albemarle, NC seeks a Financial Advocate to determine patient financial responsibility and explain costs based on insurance, deductibles, and copayments. You will initiate upfront payments, coordinate with patients on payment plans, and guide applications for coverage while maintaining HIPAA compliance.

The role requires experience in patient access or similar settings, strong communication skills, and knowledge of insurance and billing processes to help patients navigate

Qualifications

• 2 years of experience in Patient Access, health care, insurance, or customer service.
• Clear, proactive communication with management about issues involving customer service and process improvement.
• Ability to articulate explanations of HIPAA and EMTALA regulations during patient interactions.
• Solid knowledge of how various insurances operate related to denials and appeals.
• Basic medical coding knowledge.

Responsibilities

• Provide patients with personalized estimates of financial responsibility based on their insurance.
• Explain deductibles, coinsurance, and copayments and how they affect out-of-pocket costs.
• Request upfront payment toward self-pay amounts and establish payment arrangements.
• Interview uninsured patients to assess financial needs and assist with coverage paperwork.
• Coordinate Medicaid applications with state workers or vendors to maximize funding.
• Stay informed on government funding, Medicare and Medicaid rules and charity care policies.
• Educate on Financial Assistance Policy and related patient responsibilities.
• Assist in scheduling options to secure funding and clarify financial responsibility.
• Maintain HIPAA-compliant handling of patient data.

Skills

Communication

HIPAA/ EMTALA

Insurance denials

Medical coding

Billing & denials

Documentation

Education

High school diploma

GED/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.