Patient Financial Advocate

Patient Financial Advocate

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Under the general supervision and within established hospital and departmental policies and procedures, the patient financial advocate serves as a liaison between Brown University Health Cancer Institute (BUHCI), patients, and family members to determine the patient’s portion of medical expenses and develop and secure resources which may be available for the resolution of those expenses. The role obtains and verifies coverage authorizations for referrals, medications, and procedures, ensuring financial clearance from insurance companies has been received as well as coordinating the insurance denial process.

Employees are expected to role‑model the organization's values of Compassion, Accountability, Respect, and Excellence.

• Assume an advocacy role with patients, families, and their surrogates regarding outstanding patient accounts.
• Arrange and negotiate payment conditions and plans and advise patients on available resources.
• Interview patients and family members regarding financial status to assess eligibility for medical assistance or state/federal programs.
• Secure legal counsel and aid for patients and families.
• Assist patients in obtaining documentation necessary for public assistance applications.
• Maintain ongoing review of files, records and documentation on relevant programs and regulations.
• Verify patient insurance coverage (primary and secondary) online or by telephone.
• Obtain and verify coverage authorizations for scheduled and unscheduled patients, including all sources such as Workers’ Compensation, Medicare Secondary Payer, Medicare liability, and liens.
• Establish level of insurance benefits and expected payment for selected services.
• Determine patient’s portion of payment when applicable and communicate this to the patient.
• Ensure referrals are obtained and confirm accuracy of the Primary Care Physician.
• Review reports and records to ensure that referrals and pre‑authorizations from insurance companies have been received.
• Confirm patient eligibility with insurance carriers and obtain visit authorizations as necessary.
• Contact third‑party payers to obtain pre‑authorizations in accordance with established policies.
• Collaborate with physicians and mid‑level providers for peer‑to‑peer discussions to obtain prior authorization of services denied by the patient’s insurance.
• Coordinate all information for managing insurance denials.
• Collaborate with various Brown University Health personnel to resolve billing issues, prior authorizations, denials, and insurance write‑offs.
• Participate regularly in business team meetings to make recommendations where problems are perceived.
• Perform other duties as required to support the operations of the department, including registering patients, scheduling appointments, scanning and faxing documents.

• Knowledge of third‑party coverage, prior authorization processes, and referral systems.
• Current knowledge of state and federal resources for needy and disabled, including familiarity with appeals forms and documents.
• Demonstrated interpersonal skills to communicate effectively with patients, families, employees, third‑party payers, and government agencies.
• Proficient computer skills to access information and prepare and maintain records and reports.
• Strong knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and registration information.
• Strong organizational skills to plan, direct, and manage high volume of orders requiring prior authorization.
• Analytical skills to evaluate workflow effectiveness, make recommendations, and develop, review, and evaluate various records and reports.

Two years progressively responsible experience in health care with a heavy emphasis in one or more of the following areas: patient care environment, health care operations, database management, prior authorizations, referrals, documentation, and departmental operations. Knowledge of coding in a healthcare environment is a plus. Excellent analytical and critical thinking…