Patient Financial Advocate-Pan American Family Practice

Presbyterian is seeking a Patient Financial Advocate-Pan American Family Practice

Performs financial screening on hospital and medical group account activity to identify residual balances, high-deductible plan participants and self-pay patients. Requires thorough knowledge of assistance programs to include Community Benefit Application, Medicaid (PEMOSSA) application where applicable and other alternate resource programs in addition to full competency of Presbyterian policy for payment plan application. Research disputed account balances and resolve accounts with outstanding residual balances. Must possess in depth understanding of benefits administration of PHS contracts and their respective in and out of network arrangements. Comprehension of the pre-billing/pre-adjudication of claim filing to successfully identify out of pocket expense to counsel patient and/or families regarding financial responsibilities to Presbyterian. Escalates chronic no pay or bad debt accounts to supervisor
Refers patients without insurance coverage to the Financial Advocacy Center located at Main PHS for navigation of options to manage healthcare costs, including using the Market Place for obtaining health insurance coverage
Other duties as assigned

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're locally owned and operated, which encourages supportive leadership that emplowers employees. And we provide the opportunity to gorw from entry-level to the most senior positions.

Why Join Us

Full Time - Exempt: No
• Job is based at Presbyterian Northside
• Work hours: Weekday Schedule Monday-Friday
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate: Three to five years of healthcare experience in a physician office or hospital setting. Prior billing office and collection experience preferred

• Academic Preparation:
  High school or equivalent
• Experience:
• Three to five years of healthcare experience in a physician office or hospital setting
• Prior billing office and collection experience preferred
• Significant provider and patient interaction experience
  Abilities:
• Demonstrates a commitment to Presbyterian s Sense of Mission by role modeling CARES Behaviors and appropriate customer service techniques to perform patient education and act as a resource and advocate to our patients and members
• Requires detailed knowledge of operations in a medical practice in terms of what and how work is to be done as well as why it is done
• Familiarity with the Affordable Care Act and healthcare s role in assisting patients and patients families with health care costs
• Must be able to interpret data
• Comprehension of billing methodology for an integrated delivery system to include lab and other ancillary services in scope

Customer Service and Caring Practices:

• Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
• Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times
• Ability to manage conflict and appropriately request the help of a supervisor when appropriate
  
  Encounter Components:
• Calculate patient out of pocket expenses (copayment, coinsurance, residual, deductible etc.)
• Use workflow to adjust the DAR (Epic Dept Appointment Report) to alert registration staff of residual amounts for appointed patients
• In one on one patient interactions set expectation for payment when applicable
• Set up payment plans in Epic per guidelines
• Registration accuracy skills to insure correct coordination of
• Exceptional registration accuracy skills to identify errors and correct them as necessary. Serves as a resource to staff regarding account interpretations. Identify claims where filing errors have occurred and resubmit the claims to payors for consideration
  
  Financial Accountabilities:
• Collects identified patient financial obligation amounts including residual balance if applicable
• In one on one patient interactions set expectation for payment when applicable
• Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center
• Follows PMG cash handling policies and balances daily
• Keeps current on PHS financial policies, including payment plans, programs and other forms of funding
  
  Medical Record Components:
• Documents patient discussion, agreed upon outcomes and audit trail note in guarantor account notes or the auth/cert screen as applicable.
  
  Patient Relations
• Comprehend quality service connection to patient satisfaction and reimbursement
  
  Patient Safety
• Respond quickly to patients showing distress. Follow guidelines set forth by the Clinic Manger to alert the clinical team. Assist in any manner the clinic team directs.
• Ensure registration area, waiting area and walkways are clear of any unnecessary items and are clean and neat.
• Report any concern that may create a safety issue.
• Annual competency completion of Clerical Staff during a Code Blue
  
  C.A.R.E.S Behaviors:
• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter
  Professional Requirements:
• Pass annual competency exam for all areas of responsibility.
• Attend Quarterly MSO meetings.
• Attend Staff meetings
• Attend Employee Forums

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.