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Patient Financial Advocate

2 months ago

Grants, New Mexico, United States Cibola General Hospital Full time
Job Summary:

Cibola General Hospital is seeking a highly skilled Financial Services Representative to join our team. As a Financial Services Representative, you will play a critical role in providing patients with a positive financial experience by helping them navigate and understand their insurance benefits and potential financial liability.

You will serve as the patient's point of contact for financial assistance questions, communicating with patients to identify and understand their financial, social, and medical histories. You will gather all relevant information required to process financial assistance requests, including working with providers on treatment plans and medical opinions.

Key Responsibilities:
  1. Financial Assistance: Serve as the point of contact for all financial assistance related questions, communicating with patients to identify and understand their financial, social, and medical histories.
  2. Financial Analysis: Gather all relevant information required to process financial assistance requests, including working with providers on treatment plans and medical opinions.
  3. Payment Arrangements: Document all communication and follow-up in the EMR and send written confirmation to patients regarding payment arrangements.
  4. Eligibility Determination: Assess the current financial situation of patients through the verification of patient insurance benefits, serving as the technical expert in confirming patients' benefit coverage and hospital reimbursement.
  5. Financial Counseling: Determine the patient's financial ability to pay and explain insurance coverage and benefits to the patient.
  6. Financial Screening: Initiate the financial screening process as appropriate to evaluate eligibility for assistance programs.
  7. Financial Documentation: Assist patients in completing financial statements and gathering supporting financial documentation.
  8. Referral Pattern: Complete the referral pattern for patients with financial risk.
  9. Eligibility Assessment: Determine eligibility for care at Cibola General Hospital by assessing patient eligibility for Medical Assistance, Emergency Medical Assistance, Community Programs, and Government Programs.
  10. Payment Alternatives: Assess and offer payment alternatives, including prepayment for elective care, and applying for Cibola General Hospital's financial assistance program.
  11. Financial Programming: Identify eligible financial programming options and assist in completing all necessary documentation for specific federal, state, or Cibola General Hospital financial assistance programs.
  12. Urgency Assessment: With provider involvement, determine the urgency of scheduled care for patients with large financial liabilities, resulting in either a decision to proceed, hold, reschedule, etc.
  13. Payment Policy: Explain Cibola General Hospital's payment policy to patients if a program is not available to assist with payment.
  14. Liability Calculation: Calculate and explain any patient liability before or at the time of service.
  15. Payment Collection: Counsel patients on out-of-pocket liabilities and collect deductibles, pre-payments, and outstanding balances following established collection procedures, or create a payment plan with the patient and document the agreement appropriately.
  16. Service Rescheduling: If unable to establish acceptable payment arrangements for elective procedures, inform the provider and patient that services will be rescheduled or cancelled.
  17. Financial Coverage Status: Communicate financial coverage status and applicable financial decisions with all appropriate parties: patient, family, referring clinicians, and Cibola General Hospital clinicians.
  18. Account Maintenance: Assist with the maintenance of self-pay accounts, initiate collection procedures when appropriate, and send out letters to patients regarding the status of the accounts.
  19. Professional Development: Pursue and participate in education opportunities to remain current with changes in the healthcare industry.
  20. Team Collaboration: Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.
  21. Professionalism: Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
  22. Community Engagement: Attend on-site/off-site community engagement activities and on-site/off-site clinic events as needed.
  23. Additional Duties: Perform other duties as assigned.
Requirements:
  1. Education: High School Diploma / GED Required
  2. Experience: Two years' experience in healthcare Revenue Cycle preferred
  3. Skills: Excellent organization and time management skills, excellent oral and written communication skills, strong team player, ability to learn quickly, build and maintain long-term relationships, and work with minimal supervision.
  4. Knowledge: Knowledge of medical billing/collection practices, computer programs, business office procedures, basic medical coding, and third-party operating procedures and practices.
  5. Additional Qualifications: Bilingual (Spanish/English) a plus