Patient Financial Resolution Advocate

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. Updates registration/billing systems as appropriate.

19. Clear accurate documentation of all patient communications and account activities.

20. Uses system software, including online credit card systems.

21. Assists in resolving patient billing questions.

22. Communicates and interacts with clients, families, visitors, physicians, departmental and hospital staff and the public in general in a manner that demonstrates professionalism and concern for the individuals' need(s).

23. Attends departmental meetings and/or documents review of meeting minutes.

24. Contacts insurance company or employer to determine eligibility and benefits for requested services.

25. Follows up with the patient, insurance company, or provider if there are insurance coverage issues to obtain financial resolution.

26. Assists Patient Financial Services, Patient Access, and Care Management with denial management issues.

27. Communicates problems hindering workflow to management in a timely manner.

28. Prepares WVU Medicine standard consent form, notice of privacy practice and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures. Obtains electronic signature for consent to treat and patient financial obligations.

29. Maintains confidentiality according to policy and HIPAA when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information

30. Answers phone calls in a professional and courteous manner. Uses phone system in correct manner.

31. Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients, and the public. Ensures compliance by staff to hospital, governmental, and insurance regulations.

32. Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency.

33. Utilizes payer portals and payer websites to verify eligibility.

34. Participates in educational programs to meet mandatory requirements and identified needs regarding professional growth.

35. Research and process mail returns.

36. Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing.

37. Monitors accounts to facilitate timely follow-up for financial resolution.

38. Provides excellent customer service to patients, visitors and employees.

39. Participates in performance improvement initiatives as requested.

40. Obtain Certified Revenue Cycle Representative (CRCR) Certification within 1 year.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift

2. Must be able to sit for extended periods of time

3. Visual acuity must be within normal range

4. Must be able to exert more than 50 pounds of force occasionally to move patients or objects

5. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment

2. Patient care environment

SKILLS & ABILITIES:

1. Ability to accurately utilize applicable computer software and equipment for access processing

2. Demonstrates ability to follow established computer down time procedures.

3. Must have reading and comprehension ability

4. Must be able to communicate effectively

5. Must be able to read and write legible in English

6. Excellent oral and written communication skills

7. Working knowledge of computers

8. Basic knowledge of medical terminology

9. Basic knowledge of third-party payors preferred

10. Basic knowledge of time-of-service collection procedures preferred

11. Basic knowledge of business math preferred

12. Basic knowledge of ICD-9 and CPT coding preferred

13. Excellent customer service and telephone etiquette

14. Must demonstrate the ability to use tact and diplomacy in dealing with others