Patient Financial Advocate Job

Full Job Title: Patient Financial Advocate

Job Number: 17014121

Facility: SSM Health St. Mary's Hospital - St. Louis

Location: St. Louis, MO

Schedule: Full Time, Varied, Weekends, Rotating Weekends

Hours: Varied


Role Purpose:
This position is responsible for financially clearing patients for services at SSM Health. The Patient Financial Advocate (PFA) will assess all self-pay patient accounts to determine the likelihood of establishing Medicaid eligibility or the opportunity for eligibility for other financial sponsorship (i.e. Marketplace Insurance or COBRA or SSMH financial assistance programs). Follows up as outlined in policy below. Maintains positive relationships with Hospital personnel, Central Business Office personnel and outside agencies in securing optimum benefits for eligible patients. Ensures appropriate and timely payment. Functions as the facility go to person with eligibility and patient account functions. Educate patients on their financial obligations and collect out of pocket expense or sources of assistance for those unable to pay. Support facility Cashier and fill in as needed. The PFA services one or more hospital facilities and reports to the Onsite Manager, PAS Onsite.
    • Initially evaluate and apply information from Passport and State eligibility systems for Medicaid coverage and limited benefits to determine next steps.
    • Face to face screening for Medicaid eligibility, and matches patient to the correct State Medicaid Program and initiate the application process.
    • Continually review eligibility systems for changes in coverage throughout the financial process.
    • Appropriately load and communicate "found" insurance and active Medicaid prior to patient discharge to Financial Clearance and Utilization Management.
    • Secure and scan minimum required documents to begin processing of Medicaid applications including Federal and State required forms to Eligibility Services within three days.
    • Meet or exceed all revenue goals, caseload management goals (i.e. maintaining aged accounts at a designated %) and patient expectations as appropriate.
    • Work all reports as directed.
    • Refer accounts with unmet Spenddowns to the Eligibility Services Department.
    • Adjust and prioritize workload to achieve efficiency and complete screenings of all patients on a daily basis in work queues, work lists, or other workload management systems.
    • Performs billing functions to include account review, adjustments, appropriately removing accounts from bad debt prior to adding applicable insurance plan and verification of insurance eligibility functions.
    • Collect patient payments and post them accordingly to the billing system.
    • Assist with financial arrangement for patient care encounters and refer patients for payment arrangements for self-pay liabilities to Customer Service Department as applicable.
    • Screen patients for eligibility for other potential funding sources such as COBRA.
    • Function as a CMS Certified Application Counselor to assist consumers in enrolling for healthcare coverage through the Marketplace Exchange.
    • Coordinate with Financial Clearance to identify insurance coverage including estimated patient liability.
    • Work directly with medical staff (i.e. Case Management, Social Work), nursing, ancillary departments, insurance carriers and other external professionals to assist families in obtaining healthcare and financial services.
    • Provide exceptional customer service (e.g., billing, medical record, and collection inquiries) by coordinating with other patient business services functions and departments.
    • Perform cashiering functions when necessary.
    • Provide price estimations to patients, physician offices, and other providers.
    Minimum Requirements:
    • High School Degree or equivalent
    • Knowledge of CMS Regulations and Medicaid application processes.
    • One to two years of Revenue Cycle Healthcare experience
    • Working knowledge of spreadsheets and Microsoft Office Suite.
    Preferred Qualifications:
    • Associate's Degree Preferred
    • Prefer 3 – 5 years State Caseworker experience.
    • Prefer one year EPIC Electronic Health Record System experience.

SSM Health - System Office –

SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God.

SSM Health is an Equal Opportunity and Affirmative Action Employer. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Learn More »

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