Financial Advocate GCM

Carolinas Medical Center; Charlotte (NC); On-site; USD 32,000 - 47,000; Full time

Job summary

Carolinas Medical Center in Charlotte, NC, seeks a Financial Advocate to support the Enterprise Revenue Cycle - Enrollment: Southeast. This full-time role provides patients with upfront estimates, assists with insurance questions, and guides eligibility processes for coverage.

You will discuss deductibles and out-of-pocket costs, arrange payment plans, and coordinate with social workers and vendors to maximize funding options while ensuring HIPAA compliance and excellent patient service.

Qualifications

• High School diploma, GED or HSED.
• Typically 2 years in Patient Access, health care, insurance, or customer service.

Responsibilities

• Calculates and provides patients with personalized estimates of their financial responsibility based on insurance coverage prior to service.
• Explains deductibles, coinsurance, and copayments and how non-covered and out-of-network services affect out-of-pocket costs.
• Requests upfront payment and establishes payment arrangements in advance of scheduled services.
• Interviews uninsured patients to assess financial needs and coordinates with patients to complete paperwork and applications for potential coverage.
• Works with Medicaid and charity care processes to maximize funding sources for patient care.
• Educates patients and physician offices on Financial Assistance Policy and related regulations; coordinates with scheduling to secure funding.

Skills

Customer service

HIPAA knowledge

Verbal communication

Billing understanding

Education

High School diploma or GED

Job description

Department: 13447 Enterprise Revenue Cycle - Enrollment: Southeast

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

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 Commitment to You:

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

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