Patient Financial Resolution Advocate

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Interprets and applies WVUHS financial policies to make appropriate financial decisions and payment arrangements to ensure the financial viability of WVUHS. Prepares and presents fee estimates to current and potential patients. Provides financial education regarding benefits to patient to assist in understanding their personal financial liability. Demonstrates the ability to assertively pursue necessary information and to function independently to secure financial resolution on accounts. Projects a mature problem-solving attitude while dealing with interpersonal conflict, dissatisfied patients and time demands. Maintains knowledge of revenue cycle operations, third party reimbursement, local/state/federal regulations and medical terminology. Knowledge will include at minimum, all aspect of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures. Uses excellent customer service, written and oral communication skills.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High school graduate or equivalent

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1. Two (2) years of experience in a healthcare setting

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Interviews patients who are referred for financial counseling in person or via the telephone to determine financial counseling needs and to help formulate a plan for financial resolution.

2. Uses CPT codes to calculate the estimated procedure cost.  Communicates with the patient the anticipated self-pay portion for upcoming services and explores financial resolution options with the patient.

3. Based on information provided by the patient, an initial determination will be made if the patient has adequate benefits or qualifies for Medicaid, special programs or payment arrangements based on federal, state and hospital policy.  Refers patients to local, state and/or federal agencies for assistance as needed.

4. Educates patient on their benefits, patient liability and/or the process for applying for Medicaid, completion of the financial assistance application, and payment alternatives.

5. Informs patients of hospital and clinic billing practices/policies and their rights and responsibilities regarding payments.

6. Insured patients who are responsible for a balance after insurance will receive a preliminary financial overview and will be assisted in completion of the financial assistance application if necessary for financial resolution

7. Reviews completed financial assistance applications and decides eligibility based on hospital policy.

8. Works with specialty departments to establish appropriate financial arrangements for elective services.

9. Identifies and accurately resolves potential patient account issues for WVUHS billing departments

10. Monitors daily reports to identify large dollar account balances and private pay patient accounts that need resolution.

11. Displays an understanding of third-party payor regulations related to managed care, denials and reimbursement issues.

12. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters in the registration/billing systems for service and claim processing. Obtains and scan patient’s insurance/medical cards and driver’s license into the registration system.

13. Has a working knowledge of current hospital contracts with third-party payors

14. Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides the patient a receipt and documents payment in the registration/billing systems.

15. Follows up on accounts as indicated by system flags.

16. Balances daily receipts and cash drawer for patient payments, prepares and delivers deposit bag to cashier’s office

17. Initiates auto accident liability coverage.  Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems.

18. Initiates ERSD (end stage renal disease), Veterans Administration eligibility, Black Lung SSI, Workers Compensation, and Medicare Secondary Payer screenings.   U