Patient Financial Advocates - Admitting - Full time 8 Hours Days (8:00am to 4:30pm) (Non-Exempt, Union)

POSITION SUMMARY

The Patient Financial Advocate is responsible for providing Patients with a positive financial experience by helping patients navigate and understand insurance benefits and financial liability, including patients that are unfunded. The incumbent performs daily quality control on accounts, is responsible for collections of monies due, advises patients in person and over the phone of their insurance benefits and coverage, and in some cases, assesses patient referrals for appropriateness. The incumbent also assists patients with eligibility for government programs, MHSC's Financial Assistance program, and other options for managing high medical liabilities. Independent judgement and decision making is required to address the full range of tasks and responsibilities. The position requires the ability to plan, schedule and organize numerous tasks that directly impact hospital and physician reimbursement. The Patient Financial Advocate must adhere and uphold Methodist Hospital's Mission, Vision, Values and Performance Standards in providing the highest quality of service. They will support their co-workers, engage in positive interactions and provide helpful assistance in anticipating and responding the needs of our customers.

ESSENTIAL JOB FUNCTIONS AND CORE RESPONSIBILITIES

• Be cross-trained and successfully able to work in all areas of Admitting as needed by the department.
• Conducting phone and in person interviews, explaining hospital policies, obtaining treatment or billing consents and obtaining acknowledgements per type of Health Plan (Medicare forms, etc.).
• Determine patient financial status and explain patient financial responsibility and patient rights.
• Performs quality control on accounts, verifying accurate demographic and financial information, including reviewing and interpreting insurance benefits.
• Ensures notification is made to the appropriate party to initiate admission authorization per plan guidelines, per plan eligibility.
• Follows up and obtains approved authorizations for services rendered per plan guidelines.
• Records and maintains complete detailed documentation of all activities and communication performed including financial arrangements on each account daily, in real time.
• Monitors accounts daily/as needed to ensure all changes are captured and documented correctly including sending updated information per plan guidelines to ensure correct authorization for services rendered.
• Responsible to maintain at least a 90% accurate rate of all accounts reviewed.
• Identifying potential third-party liability, including Workers' Compensation, Commercial, COB Medicare and Medi-cal.
• Screens patients for financial assistance, charity or other programs and assists with completing forms and obtaining necessary documentation.
• Calculating and collecting cash payments when appropriate, including cash deposits for uninsured patients and letter or agreements.
• Notifying appropriate staff (Care Coordination, Social Services, Admitting, etc.) of cases screening determinations and outcomes, including insurance eligibility, limitations and capitations.
• Works as a liaison with DPSS LA county Medi-Cal representatives in screening and completing State/County Medi-Cal forms, including temporary Medi-Cal applications. Schedules and confirms appointments for patients or responsible party to discuss applications and documentation needed per county guidelines.
• Discuss outstanding balances with patients that are receiving current services and work closely with customer service on creating payment plans to resolve older debt.
• Participating in data gathering for financial reporting.
• Follows safety procedures, operates equipment and performs job related duties in a safe manner including reporting unsafe conditions/situations.
• Must remain informed and compliant with HIPAA, EMTALA, the Fair Debt and Collection Practices Act, and other laws and regulations that govern Patient Financial Services.
• Must remain informed regarding all HMO, PPO, Medicare, Medi-Cal and indigent service programs and requirement for timely processing of claims.
• Performs various other duties, as assigned/needed by the organization.