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.

Education
Minimum (Required) High School diploma or equivalent
Preferred (Not required) Associate degree preferred

Work Experience
Minimum (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 Transparency

The 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 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.

                                                  

USC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability, or any other characteristic protected by law or USC policy. USC observes affirmative action obligations consistent with state and federal law. USC will consider for employment all qualified applicants with criminal records in a manner consistent with applicable laws and regulations, including the Los Angeles County Fair Chance Ordinance for employers and the Fair Chance Initiative for Hiring Ordinance, and with due consideration for patient and student safety. Please refer to the Background Screening Policy Appendix D for specific employment screen implications for the position for which you are applying. 

We provide reasonable accommodations to applicants and employees with disabilities. Applicants with questions about access or requiring a reasonable accommodation for any part of the application or hiring process should contact USC Human Resources by phone at (213) 821-8100, or by email at [email protected]. Inquiries will be treated as confidential to the extent permitted by law.

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