The PFA (Patient Financial Advocate) is responsible for providing financial advocacy counseling to individuals who are uninsured.
The PFA supports SCL Healthâ™s care sites, site PFA/ FCâ™s, and patients. Determining patientâ™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 Advisorâ™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 apply knowledge of federal and state programs to benefit coverage for the patient; Medicaid, SSDI, SSI, etc.
Deliver education in regards to explaining affordability programs, qualified health plans, essential health benefits and rights when using insurance.
Educate patients about Connect for Health Colorado (C4HCO) and Health Care.gov by meeting with patients in person or via phone to explain services available, reasons to buy health insurance, and options for coverage
Is able to understand the PEAK, Connect for Health, HealthCare.gov and KanCare web-based decision tools and guide patients through the process of narrowing choices for qualified health plans
Educate and assist patients on affordable payment plan options while adhering to the SCL payment plan guidelines
Resource for Financial Health Advocates, Leads and Charity Reps, providing follow-up or research into patients pending eligibility
Full understanding of requirements of the states CICP program, processing qualifying account adjustments within acceptable timeframe
Follow up with the state on cases pending eligibility and/or contacting patient or site FHA for additional information on pending accounts requiring more than originally provided.
Responsible for maintaining and reporting out on Indigent Care work queues; Medicaid Pending, PARO scoring, CICP along with monitoring of vendor work queues
Ability to add and term coverage properly, ensuring that billing is initiated when appropriate
Primary contact for MA (Medical Assistance) Site following up submitted cases awaiting determination
Verifies information on appropriate accounts to determine insurance coordination of benefits.
Informs self-pay patients of liability due, prepayment requirements and coordinates screening of alternate funding sources if applicable
Assist management with 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
Establishes acceptable payment arrangements on self-pay accounts.
Understanding of SCLâ™s Financial Assistance Policy and procedures
Responsible for presumptive eligibility population by actively reaching out to patients, verifying quick qualification
Knowledge and understanding of the 501r Regulation
Ability to run and provide estimates to patients for services provided by SCL Health
Collects patient payments and provides receipt accurately completing all required fields
Remaining current with the Connect for Health Colorado programs and maintain certification
Complete, pass, and maintain Coloradoâ™s state certification for CAAS (Certified Application Assistance Site) Coloradoâ™s Outstationing grant program. Along with adhering to the rules and regulations set forth by the State of Colorado.
Maintains departmental and/or individual work queues and reports as required
Explains/answers patient billing inquiries and interprets statement data to resolve accounts
Demonstrates discretion in verbal and written communication with patients and SCL Health staff ensuring patient confidentiality at all times
Documents patient account notes for all interactions/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
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.