Financial Navigator I - Call Center

St. Peter's Health; Montana; On-site; USD 40,000 - 55,000; Full time

Job summary

A healthcare facility in Montana is seeking a financial navigator to assist patients with insurance coverage and financial needs related to treatment. The role requires coordinating insurance verification, educating patients about their options, and advocating for financial assistance. Ideal candidates will have an Associate's Degree and relevant experience in healthcare billing or financial counseling.

Qualifications

• Two years of healthcare billing or financial counseling.
• Experience in a community service environment such as a hospital.
• Strong knowledge of medical necessity and compliance laws.

Responsibilities

• Coordinates verification of insurance eligibility and benefits.
• Gathers financial data to determine patient eligibility for assistance.
• Guides patients to apply for programs available to aid with expenses.

Skills

Knowledge of insurance benefits

Organizational skills

Excellent communication skills

Mathematical skills

Empathy and compassion

Education

Associate's Degree in Business or related field

Tools

Microsoft Excel

Job description

Overview

This position will serve as a financial navigator to patients, identifying medical financial needs based on insurance coverage and providing guidance to patients in acquiring sustainable coverage as they maneuver through treatment. It will provide education to patients to ensure understanding and provide support, explain the financial implications of patient care and share available sources of assistance. It will act as the patient’s direct point of contact for all insurance and billing concerns during their treatment.

Responsibilities

• Coordinates verification of insurance eligibility, insurance benefits, and prior authorization to determine out of pocket responsibility for patients.
• Meets with the patient and their family to review information found for out of pocket costs before treatment starting if possible.
• Gather and assess financial data to help determine patient eligibility for Medicaid, SSI, charity and other financial assistance programs while working cohesively with associated vendors (such as MASH).
• Works as an advocate for the patient to optimize access and qualification for available benefits/assistance.
• Complete insured and uninsured patient estimates upon request.
• Provides patient education if patient is not covered or losing a group health plan coverage, and presents options of coverage they may be able to purchase.
• Tracks patients that may be transitioning from group health plans to Medicare to ensure they understand options of coverage.
• Works in conjunction with the Pharmacy Medication Recovery Coordinator to determine pharmacy programs the patient may be eligible to get assistance.
• Collaborates with the Pharmacy Medication Recovery Coordinator in entering and tracking data in the Pharmacy assistance software.
• Guides/assists patients to apply for programs available to aid with expenses outside the SPH medical bills.
• Collaborates/refers patients to SHIP so patients can optimize external assistance programs.
• Serves as a patient liaison for medical financial matters throughout treatment, including following up on insurance questions with PARS.
• Performs quarterly reviews as long as the patient is in treatment to determine financial risks to the patient.
• Projects a positive and helpful demeanor while working with patients, visitors, and staff.
• Maintains timely documentation of all pertinent information on the patient account and all other tracking tools.
• Evaluates, tracks, and logs patient assistance applications and HIPAA release of information forms.
• Handles walk-in and incoming customer service questions, including but not limited to charge explanations, relaying/explaining insurance activity, and setting up payment arrangements.
• Maintains compliance with state and federal regulations as they relate to Patient Financial Services.
• Reconciles credit card transactions and daily cash drawer.
• Functions as a liaison for the department to ensure open and effective communications between Case Managers, Patient Access, and clinical areas the patient is receiving treatment in.
• Responds to all Smart Sheet items assigned within 2-7 business days.
• Constantly seek and maintain knowledge of new/existing avenues of financial assistance and support for patients.

Qualifications

Knowledge/Experience

• Associates Degree in Business or related field OR two years of healthcare billing or financial counseling.
• Strong knowledge of insurance benefits, collections, authorizations, and pre-certifications OR an equivalent combination of education and experience.
• Experience in a community service environment such as a hospital.
• Computer skills across multiple platforms; mathematical, organizational, and business communication skills.
• Basic knowledge in downloading/creating spreadsheets in Microsoft Excel.
• Proficient with 10-key, printers, telephone, copiers, and fax.
• Familiar with medical terminology and third party payer methodology.
• Thorough knowledge of medical necessity and compliance laws.
• Excellent oral and written communication and professional skills in relating to patients and their families.
• Strong understanding of resources or programs available for patients and families.
• Ability to grasp, retain, and apply new regulations; handle stressful situations involving critically ill patients and finances; familiarity with SPH payment and patient assistance policies, verification, and billing processes for professional and facility charges.

Education

• Associcates Degree in Business or related field or two years of healthcare billing or financial counseling.
• Completed Patient Financial Services I training.
• Completed Financial Navigator certification program.

License/Certification/Registry

• None

Aptitudes

• Ability to show empathy and compassion to all people.
• Ability to manage multiple tasks, stresses, deadlines, and difficult situations with cognitive, organizational, and emotional maturity.
• Maintains standards of professional practice, confidentiality, advocacy, and ethics.
• Uses effective customer service and interpersonal skills with patients and clinic staff.
• Shows initiative and ability to self-direct to solve financial problems and collaborate with the treatment team.
• Strong interpersonal and persuasive abilities to ensure client compliance while considering the hospital’s public image and regulations.
• Excellent communication, conflict resolution, organization, follow-up, and negotiation skills.
• Ability to quickly learn and utilize software relevant to this position.
• Open to feedback and a changing environment; willing to participate in activities to enhance professional development.

Senior/Employment Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Other, Information Technology, and Management
• Industries: Hospitals and Health Care