Patient Financial Advocates
Full Time
Arcadia, CA 91007
$19.02 - $24.97 an hour
Posted
Job description
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 to 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 obtain 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 of agreements.
- Notifying appropriate staff (Care Coordination, Social Services, Admitting, etc.) of case 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 application 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 requirements for timely processing of claims.
- Performs various other duties, as assigned/needed by the organization.
- Actively initiates, manages, maintains and communicates denial/appeal activity to appropriate stakeholders and report suspected or emerging trends related to payer denials.
- Emergency room responsibilities will include coordinating with multiple departments (Unit Secretaries, Case Manager and/or other clinical staff) and the Health Plan for admissions and transfers.
JOB REQUIREMENTS
Education
Minimum (Required)
High School diploma or equivalent
Preferred (Not required)
Associates Degree preferred
Work Experience
Minimum (Required)
1 year prior experience at a health insurance company, medical office or hospital.
Preferred (Not required)
- Knowledge of medical terminology
- Knowledge of EMTALA and hospital billing and collection process
- Knowledge of third-party payer relationships as well as relevant state and federal health programs
- Knowledge of CPT/ICD-10 coding
- Proficient computer skills including various Microsoft Office programs (Excel, Outlook, Word, etc.).
- Ability to type 35+ WPM
- Ability to multi-task with excellent organization skills required
- Excellent communication skills (written and verbal), especially when under pressure
- Bilingual (English/Spanish/Cantonese/Mandarin) is preferred
Licenses and Certifications
Minimum (Required)
Preferred (Not required)
- Must be BLS certified or must provide BLS certificate within 30 days of hire.
- M.A.B. certification required. New hires must obtain within 6 months of hire.
- Complete Certified Patient Access Course and Specialist Exam within 90 days of hire.
Required Skills, Knowledge, and Abilities (SKA’s)
- Upholds MHSC’s iRAISE values daily when interacting with internal or external customers.
- Demonstrates awareness and sensitivity to rights of others, including patients and maintains confidentiality at all times.
- Consistently adhere to department/hospital dress code, appearing professional in dress, grooming and hygiene.
- Be detail-oriented, work under minimal supervision and possess problem-solving skills and meet deadlines.
- Complete continued education/training requirements as needed by the department and/or organization.
- Cultivate and foster an environment of teamwork and positive interpersonal and professional relationships.
- Actively participates in and encourages others to utilize creative and innovative approaches to accomplish tasks
- Ability to stay calm under pressure and deal effectively with difficult situations.
- Attend and actively participate in department or hospital meetings and classes, including annual fire, safety and disaster programs.
- Demonstrates responsibility for ongoing personal development, professional growth and continuing education to satisfy of exceed MHSC’s pillars of success.
- Maintain current Licenses and Certifications as required by the organization.
- Work is performed during regular work hours and may require overtime to meet deadlines.
- Position requires repetitive motion including walking, standing, sitting, reaching, bending, stooping, pulling and pushing, handling objects with hands and/or fingers, talking and/or hearing and seeing.
- Working in the Emergency Room may require the use of a WOW based on position responsibilities.
* Schedule : Dayshift Monday through Friday 8:00a-4:30p and rotating weekends and holidays. *
At USC Arcadia Hospital every team member of our 348-bed hospital strives to provide an exceptional patient experience while exemplifying our shared values of iRAISE - Integrity, Respect, Accountability, Innovation, Safety and Excellence. We achieve this through compassionate care, creating lifelong relationships by changing the way health and healthcare are delivered in our community.
At USC Arcadia Hospital, you’ll enjoy an excellent compensation and benefits package (Medical, Dental, Vision, Retirement Savings Plan with match, Life Insurance, Flexible Spending Account, Employee Assistance Program, Tuition Reimbursement, Paid Time Off, Free On-Site Parking, Child Care, Employee Referral Bonus Program, etc.), including professional development programs, and much more.
Living and Working in the San Gabriel Valley:
The City of Arcadia is located in the beautiful San Gabriel Valley, which is one of the best places to live and work in California and is just 15 miles north of downtown Los Angeles. The region offers a multitude of diverse entertainment, shopping and exceptional restaurant options. The San Gabriel Valley is less than an hour away from sunny Southern California beaches, and less than two hours away from local mountain resorts like Big Bear and Lake Arrowhead.
Locally, Arcadia is a wonderful, thriving community featuring the Los Angeles County Arboretum and Botanic Gardens as well as the Santa Anita Park racetrack, and is located next to the City of Pasadena, which hosts the New Year’s Day Rose Parade and Rose Bowl game annually. The region boasts excellent public and private schools and universities close by, including Cal Tech, USC, UCLA, Cal State Northridge, Cal Poly Pomona, Azusa Pacific University and the Claremont Colleges. Arcadia was recently named “Best Place to Raise Your Kids” by Bloomberg Businessweek magazine and is the perfect place to call home.
Pay Transparency
The hourly salary rate range for this position is $19.02 - $24.97. When extending an offer of employment, the University of Southern California Arcadia Hospital considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, State, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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