Presbyterian Healthcare Services Patient Financial Advocate in Albuquerque, New Mexico
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
Type of Opportunity: Full Time
Work Schedule: Weekday Schedule Monday-Friday
*High school or equivalent
*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
*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
- High School Diploma or GED
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
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
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.
- Comprehend quality service connection to patient satisfaction and reimbursement
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
- Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter
Pass annual competency exam for all areas of responsibility.
Attend Quarterly MSO meetings.
Attend Staff meetings
Attend Employee Forums
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
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. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. 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 - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About Our Regional Delivery System
Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Requisition ID: 2022-31385
Street: 1100 Central Avenue SE
JobTitle: Patient Financial Advocate