Patient Financial Advocate (Healthcare)

The Patient Financial Advocate, under the general direction of the Director of Financial Support Services, works collaboratively with patients, family members, team members, and other departments by assisting, optimizing, coordinating, and clarifying opportunities to help patients understand and cover healthcare costs. For the patient, the team member is critical in assisting with understanding and optimizing health insurance coverage, external assistance programs, and government assistance programs. The Patient Financial Advocate's core responsibility is to ensure that all patients are able to receive world-class care and that all options are exhausted to help reduce financial toxicity while ensuring that the CARTI cancer program is able to collect on services provided. Other duties include providing patients and families a clear overview of treatment costs, acting as the patient's direct point of contact for all insurance and billing inquiries, and ensuring that patients have all necessary resources and information to make and maintain their appointments with a clear understanding of financial implications and coverage options. Understand the mission of a CARTI Patient Financial Advocate is to provide caring and compassionate care, while demonstrating empathy, to all CARTI patients, families, and team members. The Patient Financial Advocate will advocate for CARTI patients while protecting CARTI's financial interests.

SPECIFIC JOB DUTIES AND RESPONSIBILITIES: Include the following. Other duties or tasks may be requested or assigned by immediate supervisor, his/her designee or management.

Provides excellent customer service to patients remotely and in-person on a daily basis.
Works with patients to help understand and optimize health insurance and supplemental coverage options for medical and pharmacy benefits.
Works closely with Provider and Nursing Staff in proactively assisting, on a daily basis, with investigating, attaining, and activating patient financial assistance for medications dispensed from a pharmacy. Completes new and renewal applications, communicates with patients, and assists in entire process in order to activate financial assistance options for patients.
Works closely with the Social Work Team Lead in proactively assisting, on a daily basis, with investigating, attaining, and activating patient financial assistance options that may be available to the patient through external entities and internal grants/foundation.
Serves as a subject matter expert on the Patient Financial Advocate Team in all patient assistance programs (including, but not limited to programs managed by and available through Social Work, Physician Dispensing, and Oral Oncolytic departments/units of CARTI).
Provides patients and families with a clear overview of their treatment costs. (Pre-estimates)
Identifies, determines eligibility, and enrolls patients into available co-pay, foundation, pharmaceutical assistance programs, and other patient assistance programs.
Assists patients with enrolling in Medicaid and other government-sponsored healthcare assistance programs.
Acts as the patient's is direct primary point of contact for all insurance and billing inquiries.
Determines patient responsibility and performs appropriate point of service collection.
Collects Payments due on Account.
Enrolls patients in payment plan arrangements.
Verifies current insurance coverage, including out-of-pocket costs, deductibles, and/or coinsurance as necessary.
Works closely with Medical Providers, Third-Party Payors, Business Office Team Members, Social Workers, and other CARTI organizational departments to coordinating the financial aspects of a patient's care.
Reviews patient accounts for deficiencies and errors, and coordinates corrections with other departments as necessary.
Identifies and contacts billing in regard to all delinquent CPA accounts according to the collection guidelines and policies.
Assists patients with completing and validating applications for government-sponsored healthcare programs, patient assistance programs, CARTI patient assistance programs, and other hardship relief or assistance programs. Coordinates the application process until completion.
Requests correct/updated information from patients.
Clearly communicates with Management on any issues of concern in a timely fashion.
Acts as a liaison to assist patient with navigating complexities of internal processes or to resolve patient inquiries, concerns, or complaints that staff member is made aware of.
Make and answer telephone calls from patients.
Review providers Radiation, Infusion and Imaging schedules, checking patients' accounts for high patient and insurance balances communicating with the billing team if needed for additional claim follow up.
Review patient chemotherapy protocols and determine insurance benefits and patient responsibility.
Establish and discuss payment arrangements with the patient and document appropriately in the practice management system.
Work with pharmaceutical companies and other resources to obtain grants and financial aid for patients in need.
Document is pharmacy ordering, ticketing, EMR and billing systems
Other Duties as Assigned: Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

OTHER JOB REQUIREMENTS: Other job requirements as assigned.

SUPERVISORY RESPONSIBILITY: N/A

EDUCATION, CERTIFICATION, LICENSURE, REGISTRATION:

High School Diploma or equivalent. Required
Associate degree or higher in Healthcare, Business, Accounting, Legal, or comparable. Preferred.
One or more Active Healthcare Certifications Preferred (from HFMA, AAPC, AHIMA, or equivalent)

EXPERIENCE, KNOWLEDGE, SKILLS, and ABILITIES:

Minimum of two years' medical collection experience
Two years of medical insurance background, preferred
Strong Applied Knowledge of Patient Assistance Programs for Medical and Pharmacy Benefits
Knowledge of The Affordable Care and No Surprise Act
Knowledge of medical billing/collection practices
Knowledge of computer programs, spreadsheets, and applications
Knowledge of basic medical coding and third-party operating procedures and practices
Knowledge of legal and regulatory governmental provisions

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, or schedule form.

INTERPERSONAL SKILLS:

Must interact and communicate both verbally and in written form.
Must interact and exchange information regarding patients with physicians and other departmental personnel, and outside agencies on a frequent basis while respecting the confidentiality of patient information.
Must uphold the CARTI values at all times and be willing to assist patients and staff when needed.

PHYSICAL DEMANDS:
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.

While performing the duties of this job, the employee is regularly required to talk or hear.
The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:
The work environment described here is representative of those an employee encounters while performing the essential functions of this job.
This position involves potential exposure to infectious diseases. Team members are offered appropriate vaccinations and safety training.

COMMENTS:
This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of the job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.