Financial Advocate

Summary:
Performs financial screening on hospital and medical group account activity to identify residual balances high-deductible plan participants and self-pay patients. Requires thorough knowledge of assistance programs to include charity care application Medicaid (PEMOSSA) application and other alternate resource programs in addition to full competency of Presbyterians policy for payment plan application.

In depth understanding of benefits administration of PHS contracts and their respective in and out of network arrangements. This role requires comprehension of the pre-billing/pre-adjudication of claim filing to successfully identify out of pocket expense the patient should anticipate. Possess a broad understanding of Presbyterians affiliates and their billing methodologies.
Successfully counsel patients and/or families regarding financial responsibilities to Presbyterian. Ability to use standardized procedures that emphasize assertive steps to resolve and gain reimbursement of patient financial obligatory amounts using CARES Behaviors. Ability to research disputed account balances and resolve accounts with outstanding residual balances. Escalates chronic no pay or bad debt accounts to superior.
Demonstrates a commitment to Presbyterian s Sense of Mission by role modeling CARES Behaviors and appropriate customer service techniques to perform patient education and act as a resource and advocate to our patients and members.

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

Other information:
High School (G.E.D.) required. Three to five years of experience in healthcare field with significant MD and patient interaction required. Physician office or hospital experience preferred. Prior billing office and collection experience preferred. Must be able to demonstrate competency in registration with the ability to pass all Epic competencies within 30 days of hire. Requires detailed knowledge of operations in a medical practice in terms of what and how work is to be done as well as why it is done this level includes interpretations of data. Proficient in ICD-9 Medical Terminology and CPT. Basic excel experience preferred for reporting requirements. Demonstrated ability to communicate effectively and work cooperatively with the public as well as all levels of staff and management

Education:
Essential:
* High School Diploma or GED

Responsibilities:
*Calculate patient out of pocket expectation (co-insurance co-payment deductible residual amounts) and alert patient to that balance prior to upcoming visit. Use coding knowledge to calculate charges for more complicated levels of service (modifiers lesions etc). Contact patient to set the expectation for payment during the visit. Offer an appointment to review account when questions exist.

*Successful collection rate of residual high-deductible and self pay amounts in a courteous professional manner using CARES Behaviors.

*Exceptional registration accuracy skills to identify errors and correct them as necessary. Serves as a resource to staff regarding account interpretations. Identify claims where filing errors have occurred and resubmit the claims to payors for consideration.

*Demonstrated competence in using patient estimator technology and on line tools available to provide a reasonably accurate out of pocket expense expectation for patients and their guarantors.

*Facilitates the operations of the clinic or hospital by providing support to clerical staff to discuss account activity with patients and guarantors. Communicates appropriate situations to Clinic Manager DPO and Patient Access Supervisor.

*Keeps current on PHS financial policies including payment plans programs and other forms of funding.

*Comprehension of billing methodology for an integrated delivery system to include lab and other ancillary services in scope.

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program including free access to our on-site and community-based gyms nutrition coaching and classes wellness challenges and more!

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