Patient Financial Advisor

A patient financial advisor at a hospital assists patients in understanding their medical bills, insurance coverage, and payment options. They provide guidance on financial assistance programs and help patients navigate billing processes to ensure clarity and reduce stress. The advisor also works collaboratively with hospital staff to address patient concerns and promote overall satisfaction.

Job Standards and Performance Expectations

1. Customer Service
   1. Educates, screens, and assists patients who do not have valid insurance coverage to enroll in third-party eligibility programs. Interviews qualified patients for potential funding sources, which may include Medicaid, financial assistance programs (FAP), and/or alternative funding sources. Performs all associated functions timely and accurately.
   2. Educates patient during interview on applicable policies such as point-of-service collection, payment options, and financial assistance. Performs follow up with patient and the Division of Medicaid to ensure appropriate completion of applications and submission of all required documentation. Stays informed on applicable statues, regulations, and Office of Compliance policies that affect assigned tasks.
   3. Submits Medicaid applications timely and accurately.
   4. Meets with patients who present as self-pay to obtain valid insurance coverage, if applicable, and/or review prior account information to obtain insurance coverage. Notifies departments of information and updates patient accounts.
   5. Consistently interacts with sensitivity to patients/their families and is responsive to individual needs. Exhibits excellent customer service and communications skills, with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families.
   6. Serves as billing office customer service support in assisting patients/guarantors and employees with billing inquiries; to include payer benefits, EOB review, collections and establishing payment plans in-house or vendor referral.
   7. Serves as support to patients and their family members to assure customers have access to all available funding.
2. Critical Thinking
   1. Analyzes patient financial condition based on interview and inputs into financial counseling system. Documents all calls, correspondence, and related activities to each patient's account in the correct place using appropriate tools and language. Updates patient accounting information systems.
   2. Responsible for calculating patient out-of-pocket amounts due and collecting on those amounts for unscheduled inpatient and observation admits having insurance coverage. Utilizes effective critical thinking skills and professional approach when handling these collections situations.
   3. Maintain complete records of all patients applying for indigent or financial assistance to include the application, proof of income, the acceptance/denial letter, and any other applicable documentation.
   4. Verifies and assures all accounts are ready for routing for approval for charity or billing with adequate supporting documentation within the established time frames.
   5. Demonstrates ability to work independently, be attentive to detail, and ensure work is completed timely and accurately. Works in self-directed manner and requires minimal supervision.
   6. Demonstrates ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks.
   7. Identifies trends that may indicate problem areas and alerts Supervisor/Manager/Director of such. Plays key role in initiating solutions.
3. Interpersonal Relations
   1. Work closely with Case Management (UR) on a daily basis in regard to notification of active Medicaid coverage, authorizations, and changes to Healthy Louisiana Plans; obtains needed authorization and forwards to Utilization Management when received.
   2. Maintains daily contact with Utilization Management, Business Office, patient Registration, Medical Records, Ancillary departments, various third-party agencies, HMO/PPOs, patients, patient families, physician offices and other outside entities.
   3. Actively participates in and encourages other to utilize creative and innovative approaches to accomplish tasks.
4. Other Duties as Assigned
   1. Performs other duties as assigned.

Education: Bachelor's Degree

Experience: 1 year of experience in financial services, insurance, or billing/patient accounts