Patient Financial Services Advocate

Description

Now Hiring – Patient Financial Services Advocate

Location: Fort Myers, Florida – On-site (3660 Broadway)-Remote with on-site training 

Radiology Regional is one of the largest physician-driven diagnostic imaging providers, with 13 imaging centers in Southwest Florida. We are seeking a dynamic person with a passion to care for others in the communities we serve. For over 50 years we have earned trust and confidence because of their patient care experience. 

Position Summary

Understanding the dynamics of the healthcare system requires a detailed knowledge of the interactions between providers in the healthcare marketplace. In addition, reimbursement of those services also requires a detailed knowledge of the mechanisms, clinical and financial prerequisites that must be present for a health plan to procure benefits to a covered member.

During the normal course of scheduling patients for care, when it is determined that any one of more of the clinical and/or financial prerequisites are not met, this role makes best efforts to coordinate the resources of clinical and financial solutions for the patient to have access to the care delivery system.

Essential Job Responsibilities

This position will receive referrals from the Scheduling, Revenue Cycle or clinical areas where a patient’s clinical or financial prerequisites are not met. This position does not order or otherwise render care but assists in resolving those issues that may inhibit access to the patient’s health plan benefits or care delivery system.

It is the intent and goal of this role to clear those obstacles that are inhibiting access to the patient’s health plan benefits or the care delivery system itself. Patients often choose, or are chosen for them, health plans with limitations and restrictions. The following list represents examples of some of the situations that may be referred to the Patient Advocate for resolution.

• The provider has a verbal order for services and requires a written order for those services to be rendered.
•  The health plan has a limitation and restriction that certain services align with diagnosis codes on the clinical order before benefits can be applied, yet the patient’s order does not contain a diagnosis that represents a covered benefit for this health plan.
• The health plan has a limitation and restriction that benefits are only available for network providers and the provider is not contracted with the health plan. Accordingly, no benefits are available under the patient’s health plan.
• The health plan has a limitation and restriction that certain services require authorization before the care is a covered benefit, yet the team has been unable to obtain the authorization prior to the service being rendered.  
• The health plan has a limitation and restriction that certain services require a referred from the patient’s Primary Care Physician before the care is a covered benefit, yet the team has been unable to obtain the referral prior to the service being rendered.
• The patient is covered by a plan and due to other limitations and restrictions, is not expecting any benefits to be paid on the service.
• The patient has a high deductible health plan where a substantial portion of the deductible is unmet, and the patient chooses a discounted cash price in lieu of their health plan’s pricing.
• The above list is only for reference, not a complete list of duties or scenarios that would be referred to the Patient Advocate.

Statistics 

As mentioned in the Position Summary section of the Job Description, the intent and goal of the position is to clear obstacles to assure that the patient receives care that is ordered and also that payment to the provider is realized. To measure the success of the program, the Patient Advocate will maintain a log indicating the inbound referral and the ultimate disposition of the case. Goals are achieved when a high proportion of the inbound cases result in the patient receiving the care that is ordered and appropriate payment for services is made.

Goals and statistics will be monitored and adjusted as necessary.

• Competitive medical, dental and vision benefits plans 
• Life and long-term disability insurance 
• Three weeks paid time off 
• 401k with a generous company contribution
• Six paid holidays 
• Imaging services for employees and immediate household 

And much more!

Requirements

Knowledge & Skill Requirements 

Required: High School Diploma or GED. In addition, any training, certification and special study into the financial or clinical sides of the healthcare delivery system are preferred. A bachelor’s degree in a related field of study is also preferred.

Experience: The position requires five years, or more, of related experience with a good understanding of the healthcare delivery system and health plan benefit systems. Prior management experience is preferred.

Radiology Regional is an Equal Opportunity Employer.