GENERAL SUMMARY:<br />The Patient Financial Advisor is responsible for ownership of patient financial obligations for inpatient, and select outpatient, encounters. They are responsible for ensuring that AHC receives payment for services provided by SGAH, WAH, PHR, and BHW. To this end, they will do any or all of the following:<br />• Insured patients:<br />o Confirm coverage requirements for scheduled patients<br />o Confirm eligibility for insured patients<br />o Obtain needed authorization for service where applicable for insured patients<br />o Monitor patient service counts to ensure services are aligned for payments<br />• Uninsured patients:<br />o Identify appropriate sources for patients based upon FPL guidelines<br />o Appropriately assess ability for payment plans or discount plans<br />o Appropriately refer patients to other payment sources (i.e. Medicaid eligibility vendor)<br /><br />The Patient Financial Advisor may determine best payment solutions or impact of payment changes at any time during the patient revenue workflow, based on experience and knowledge:<br />• Pre-service (Scheduling, Pre-registration, etc prior to DOS) <br />• Point of Service<br />• Post Service and Pre-claim<br />• Post Service and Post Claim<br />• Post Remittance<br />• Pre-Collection<br /><br />PRINCIPAL DUTIES AND RESPONSIBILITIES:<br /><br />SERVICE<br />• Demonstrates excellent patient service skills, assists in problem resolution both internal and external.<br />• Assists patient in identifying and/or obtaining financial options to pay for medical services<br /><br />LEADERSHIP<br />• Promote teamwork and a positive work environment.<br />• Communicates to management when issues arise.<br />• Demonstrates an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management<br />• Assist all non-financial team members regarding patient financial options and/or programs<br /><br />INNOVATION<br />• Is considered an SME regarding patient financial payment solutions and the impacts of solutions and inaccuracies and how they lead to non-payment. They can be relied upon to think proactively and independently <br />• Independently problem solves and identifies opportunities for improvement<br />• Works with management in developing new financial policies where appropriate<br /><br />PROCESSES<br />• Completes follow-up in accordance to department policy.<br />• Escalate appropriate issues to management<br />• Verify accuracy of all insurance information <br />• Conducts patient account assessments<br />• Confirms insurance eligibility for insured patients<br />• Obtains authorizations services where appropriate<br />• First resolution for to resolve patient financial concerns <br />• Monitors patient accounts to ensure service utilization is within compliance (days, service counts, sessions, etc.)<br />• In partnership with case management, social work, or other support team:<br />o monitors daily census and/or schedules, etc. to identify patients requiring financial follow-up<br />o ensures all payor elements and required authorizations are obtained prior to patient discharge where appropriate and within compliance<br />o support and or assist in patient discharge planning and identifying payment solutions to support that process<br />o ensures service orders, patient statuses, and resulting financial obligations are updated in system<br />o provides financial obligations summaries to patients and care team as appropriate<br />• Attempt to ensure patient liabilities are paid in full at time of service or prior to inpatient discharge.<br />• Support and assist PA and CM teams by identifying and providing accurate financial obligations<br />• Communication clearly to patient or patient designee, insurance coverages/benefits, patient financial obligations, and impact of unpaid services<br />• Meet or exceed PFA targets for self, team, department, entity, and/or AHC<br />• Other duties as assigned<br /><br />DISTRIBUTION OF DUTIES<br />• PFA I: Supports pre-service processes <br />o Scheduling and coverage authorization of scheduled services<br />• May require physician/clinical communication<br />o Pre-registration of scheduled services to include coverage verifications and authorizations<br />o Assisting patients in completing AHC charitable applications at the medical centers<br />• PFA II: Supports current care plan and through-put within acute medical center on-site acute services.<br />o Supports financial processes including authorizations, verifications, and financial options for patients in-house as stated above. <br />o Tracks available service days.<br />o Works with CM to ensure patients financial obligations are met<br />o Coordinates with CM to support discharge planning<br />o Coordinates and collaborates with current eligibility vendor<br />o Provides direct patient financial counseling if appropriate<br />o Assisting patients to complete AHC charitable applications at the support center location<br />o Works with limited direct supervision<br />o Can complete all PFA I duties if required<br />• PFA III: Acts as PFA Leads<br />o Act as SME for the PFA roles<br />o Provides escalation oversight for PFA processes<br />o May provide process direction for all PFA roles<br />o Provide feedback to PFAs and Revenue Cycle Leaders for PFAs<br />o Ensures compliance of all policies and procedures by staff<br />o Acts as thought partner for financial policies and procedures as they relate to coverage verifications, authorizations, financial options, and AHC financial assistance<br />o Can complete all PFA I and II duties when required and as a floater if needed<br /><br />EDUCATION / TRAINING REQUIREMENTS:<br />• PFA I:<br />o Minimum of 2 years experience within a healthcare financial environment. Can include insurer or public health setting as well. <br />o High School Graduate or equivalent. <br />• PFA II: <br />o Minimum of 3 years experience within a healthcare financial environment. Can include insurer or public health setting as well. <br />o At least 1 years establishing eligibility and/or payment authorizations<br />o Requires strong knowledge/training in government payor rules and regulations<br />o Requires strong knowledge/training regarding TPLs, WC, and other payment sources and liabilities<br />o High School Graduate or equivalent. Some college preferred.<br />• PFA III: <br />o Minimum of 5 years experience within a healthcare financial environment. Can include insurer or public health setting as well. <br />o At least 3 years establishing eligibility and/or payment authorizations<br />o Requires strong knowledge/training in government payor rules and regulations<br />o Requires strong knowledge/training regarding TPLs, WC, and other payment sources and liabilities<br />o Requires knowledge of MD state regulations, 501R, payment, billing, and adjudication processes<br />o Some college or post HS education required<br /><br />• Ability to work independently and in a team environment.<br />• Must maintain a high level confidentiality <br />• Must work well in stressful environments without compromising quality and accuracy.<br />• Strong Customer Service skills<br />• Ability to participate in an environment that promotes staff development, productivity, satisfaction and efficiency<br />• PC skills in a Windows environment are required. Knowledge and utilization of desktop applications to include Word and Excel is helpful.<br />• Ability to initiate and follow through on projects and work independently.<br />• Strong written and verbal communication skills.<br /><br />WORKING CONDITIONS:<br />• Frequent pressure due to deadline requirements<br />• Frequent travel between AHC sites and patients<br />• Requires judgment that could affect performance and the image of the organization.<br />• Frequently works at PC involving focused concentration.<br />• Occasional walking, bending, lifting, stooping, kneeling/crouching, sitting etc.<br />• Light physical effort (lifts or carries up to 10lbs)<br />• Atmosphere and environment associated with an office setting<br />• Must maintain a professional appearance and demeanor at all times<br /><br />SPECIAL REQUIREMENTS<br />• This position is within the Revenue Cycle division of AHC and lead/managed by Navigant Cymetrix. <br />• This position requires incumbents commit to at least one year in role prior to applying for other positions outside of Revenue Cycle<br /><br />Work Schedule:<br /><br />This is a surgical scheduling position at WAH/WOMC . The employee will be responsible for scheduling surgical procedures for the O.R.. Attention to detail is a must have trait. Knowledge of medical terminology is also required for this position.<br /><br /><b>Tobacco Statement</b><br /><br />Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.<br /><br />Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.<br /><br /><b>Equal Employment Opportunity</b><br /><br />Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.