Patient Financial Advocates - Admitting -… at USC Verdugo… · ARH…

Summary: USC Verdugo Hills Hospital is seeking a Patient Financial Advocate to enhance the financial experience for patients by guiding them through insurance benefits and financial responsibilities. The role involves conducting interviews, ensuring accurate account documentation, and assisting patients with financial assistance programs while adhering to hospital standards. 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 Required Qualifications: - High School diploma or equivalent - 1-year prior experience at a health insurance company, medical office or hospital - 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 Preferred Qualifications: - Associate degree preferred Required Skills: Insurance benefits, Financial liability management, Account quality control, Patient financial status assessment, Insurance authorization processing, Third-party liability identification, Financial assistance screening, Cash payment collection, BLS certification, M.A.B certification, Certified Patient Access Course