Employment Type:

Full time

Shift:

Rotating Shift

Description:

At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.

POSITION PURPOSE:

The Patient Benefit Advocate I is responsible for coordinating payment sources and other activities related to securing reimbursement for hospital services rendered to patients who are either already admitted to our hospital or who may be seeking to obtain services. The Patient Benefit Advocate I will educate and assist patients with understanding their insurance options, setting up payment arrangements, and collecting patient financial responsibilities, while also assisting with any and all avenues of financial assistance available to them. The Patient Benefit Advocate I will perform all functions in a courteous and respectful manner, advocating for the patient’s best interest and wellbeing.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• High school diploma or an equivalent combination of education and experience. Associate degree in Accounting or Business Administration highly desired. 
• Past work experience of at least two to three (2-3) years within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service activities is preferred. 
• Working knowledge of medical terminology, anatomy and physiology, and medical record coding (ICD-10, CPT, HCPCS) is preferable.
• Completion of regulatory/mandatory certifications and skills validation competencies preferred.
• Notary public credentials preferred.

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Core Values, and Vision in behaviors, practices, policies and decisions. 
• Works with vendors and patients in applying for routine insurance coverage.
• Develops positive relationships with vendors and hospital personnel.
• Educates patients on routine insurance coverage and financial assistance options, when appropriate. Assists with application process for patient coverage. 
• Calculates and provides patient pricing estimates for services upon request of patient.
• Refers patients to patient loan programs as necessary.
• Collects any patient liabilities due and performs routine cashiering functions.
• Identifies routine issues and either resolves or escalates to Lead Patient Benefit Advocate to resolve.
• Works with contracted vendors/agencies to qualify applicants for insurance coverage, reviewing each case prior to agency placement. Provides pricing estimates and communicates pre-service patient liability based on expected charges and potential coverage. 
• Performs benefit advocacy functions for patients on a pre-service, point of service and post-service basis. 
• Interviews patients and/or their representatives, by adapting and utilizing interviewing techniques to meet respective needs, educational levels, and abilities of the interviewee, to accurately update demographic, clinical, financial and insurance data necessary to complete the benefit advocacy process and screen patients for financial assistance. 
• Reviews prior account notes for past due balances and any information that might aid in the application/payment process and documents all encounters and actions. 
• Informs patients/guarantors of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of contact. Utilizes available tools to calculate patient liabilities. 
• Interacts and collaborates with numerous departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
• Initiates requests for charity write-offs, when appropriate.
• Monitors accounts in the self-pay or eligibility pending financial class and following up to provide account resolution.
• Interprets data, draws conclusions, and reviews findings with Lead Patient Benefit Advocate for further review.
• Takes initiative to continuously learn all aspects of Patient Benefit Advocate role to support progressive responsibility. 
• Other duties as needed and assigned by the manager.
• Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
• Knowledge of insurance and governmental programs, regulations and billing processes e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.

Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health!

Visit www.saintalphonsus.org/careers to learn more about the benefits, culture, and career development opportunities available to you at Saint Alphonsus Health System.

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Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.