The PFA (Patient Financial Advocate) is responsible for providing financial advocacy counseling to individuals who are uninsured.
The PFA supports SCL Health's care sites, site PFA/ FC's, and patients. Determining patient's medical financial needs by assisting patients directly or indirectly applying for Medicaid coverage, qualifying for State or Federal programs, education of the Affordable Care Act, presenting patients with payment plan options, and identifying individuals who are in need of Financial Assistance. The Financial Advisor's function as back office support for the onsite Advocates. Providing answers to qualification questions, research, and support.
This position is responsible for quality assurance in application processing and procedures, along with adhering to all compliance requirements mandated by CMS, HIPAA, JCAHO, etc.
Acts as liaison between departments located at the care site and/or RSC; fostering open communication and team work, utilizing positive and effective communication with all team members.
Ability to applyknowledge of federal and state programs to benefit coverage for the patient;Medicaid, SSDI, SSI, etc.
Delivereducation in regards to explaining affordability programs, qualified healthplans, essential health benefits and rights when using insurance.
Educate patientsabout Connect for Health Colorado (C4HCO) and Health Care.gov by meeting withpatients in person or via phone to explain services available, reasons to buyhealth insurance, and options for coverage
Is able to understand the PEAK,Connect for Health, HealthCare.gov andKanCare web-based decision toolsand guide patients through the process of narrowing choices for qualifiedhealth plans
Educate and assist patients on affordable paymentplan options while adhering to the SCL payment plan guidelines
Resource forFinancial Health Advocates, Leads and Charity Reps, providing follow-up orresearch into patients pending eligibility
Fullunderstanding of requirements of the states CICP program, processing qualifyingaccount adjustments within acceptable timeframe
Follow up with the state on cases pendingeligibility and/or contacting patient or site FHA for additional information onpending accounts requiring more than originally provided.
Responsible for maintaining and reporting out onIndigent Care work queues; Medicaid Pending, PARO scoring, CICP along withmonitoring of vendor work queues
Ability to add and term coverage properly,ensuring that billing is initiated when appropriate
Primary contact for MA (Medical Assistance) Sitefollowing up submitted cases awaiting determination
Verifies information on appropriate accounts todetermine insurance coordination of benefits.
Informs self-pay patients of liability due,prepayment requirements and coordinates screening of alternate funding sourcesif applicable
Assist managementwith Quality Review
Assists with special projects; audits, reporting,research, etc.
Acts as a SME (Subject Matter Expert)
Assists with new hire and remedial training
Daily monitoring of system site work queues,reporting out monthly KPIs to leadership
Establishesacceptable payment arrangements on self-pay accounts.
Understanding ofSCL's Financial Assistance Policy and procedures
Responsible forpresumptive eligibility population by actively reaching out to patients,verifying quick qualification
Knowledge andunderstanding of the 501r Regulation
Ability to runand provide estimates to patients for services provided by SCL Health
Collects patient payments and provides receiptaccurately completing all required fields
Remaining current with the Connect for HealthColorado programs and maintain certification
Complete, pass, and maintain Colorado's statecertification for CAAS (Certified Application Assistance Site) Colorado'sOutstationing grant program. Along with adhering to the rules and regulationsset forth by the State of Colorado.
Maintains departmental and/or individual workqueues and reports as required
Explains/answers patient billing inquiries andinterprets statement data to resolve accounts
Demonstrates discretion in verbal and writtencommunication with patients and SCL Health staff ensuring patientconfidentiality at all times
Documents patient account notes for allinteractions/transactions in EPIC and/or CAC Tracker
Computer knowledge including experience with Microsoft Office Suite.
High school diploma / GED or equivalent
2+ years of Hospital site Financial Counseling
1+ years previous experience ACA enrollment
Medicaid qualification knowledge
Understanding of State and Federal Programs available to the indigent care population i.e. food stamps, Medicaid expansion,SSI, SSDI, etc.
Financial Counseling experience - 3+ years
Medicare and Insurance knowledge
Bilingual - Spanish
Ability to read and understand profit statements
Previous hospital/medical office, medical insurance and/or customer service experience preferred
Previous Certified Application Counselor training (CAC) - State and/or Federal
Ability to read, understand and apply personal tax return information
We reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.
Inspired by our faith,
•We will be distinguished as the premier person-centered health system and trusted partner.
•We will share accountability with clinicians and other stakeholders to coordinate care across all settin...gs and improve access, quality, health outcomes, and affordability.
•We will grow as community-based health networks to serve more people in partnerships with others who share our vision and values.
Caring Spirit - We honor the sacred dignity of each person.
Excellence - We set and surpass high standards.
Good Humor - We create joyful and welcoming environments.
Integrity - We do the right thing with openness and pride.
Safety - We deliver care that seeks to eliminate all harm for patients and associates.
Stewardship - We are accountable for the resources entrusted to us.