Patient Financial Advocate

Cape Fear Valley Health; Fayetteville (NC); On-site; USD 36,000 - 46,000; Full time

Job summary

Cape Fear Valley Health in Fayetteville, NC seeks a Patient Access Specialist to manage preadmission and registration tasks, verify insurance, determine authorizations, and collect patient financial responsibility by phone or at point of service.

The role supports accuracy in patient accounts, works with HIPAA guidelines, and communicates clearly with patients, physicians, and payers; prior hospital/medical office experience preferred; CPAS certification required within 1 year.

Qualifications

• Proficiency in reading, writing, and speaking the English language.
• Knowledge of insurance and collection of payments.
• Knowledge of Medical Terminology.
• Knowledge of Microsoft software.
• Excellent verbal and written communication skills, customer service skills and problem-solving abilities.
• Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
• May be required to periodically rotate shifts and regular days off.
• All system employees must have the flexibility to meet the department hours of operation.

Responsibilities

• Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits.
• Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.
• Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered
• Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).
• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.
• Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance.
• Properly screens appropriate patients for market insurance.
• Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record.
• Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed.
• Assists insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.
• Meets or exceeds accuracy standard goal determined by Patient Access Leadership; Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation.
• Other duties as assigned

Skills

Insurance verification

Communication

Medical terminology

Customer service

English literacy

Education

High school diploma

Associates degree in Health Care Admin or Business

CPAS certification

Tools

Microsoft Office

Job description

Cape Fear Valley Health in Fayetteville, NC seeks a Patient Access Specialist to manage preadmission and registration tasks, verify insurance, determine authorizations, and collect patient financial responsibility by phone or at point of service.

The role supports accuracy in patient accounts, works with HIPAA guidelines, and communicates clearly with patients, physicians, and payers; prior hospital/medical office experience preferred; CPAS certification required within 1 year.