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, MHSCs 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 Hospitals 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.

EducationMinimum (Required)High School diploma or equivalentPreferred (Not required)Associate degree preferredWork ExperienceMinimum (Required)1-year prior experience at a health insurance company, medical office or hospital.Licenses and Certification Minimum (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.Pay TransparencyThe hourly salary rate range for this position is $21.00- $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 candidates 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.

About University of Southern California (USC)

USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations. As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.

Connections working at University of Southern California (USC)

Job Tags

Hourly pay, Full time, Temporary work, Work experience placement, Local area,

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