Patient Financial Advocate

SUMMARY

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 to ascertain, develop and secure resources that may be available to patient and family members for the resolution of medical expenses incurred.

Obtains and verifies coverage authorizations for referrals, medications, and procedures, ensuring financial clearance from insurance companies has been received and coordinating the insurance denial process.

Brown University Health employees are expected to role‑model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors that describe how we work together and how we get things done.

• Instill Trust and Value Differences
• Patient and Community Focus and Collaborate

• Assumes an advocacy role with patients and/or families and their surrogates regarding the resolution of outstanding patient accounts.
• Arranges and negotiates payment conditions and plans, and advises and counsels patients regarding available resources from which payments can be made.
• Interviews patients and family members regarding their financial and dependency status or other factors that may help promote eligibility for medical assistance or other state and federal programs.
• Secures legal counsel and aid for patients and families; assists patients in obtaining documentation necessary to apply for public assistance.
• Makes a continuing review of files, records, and other forms of documentation on state and federal programs and regulations.
• Verifies patient insurance coverage (both primary and secondary) online or by telephone.
• Obtains and verifies coverage authorizations for scheduled and unscheduled patients, including all sources such as Worker’s Compensation, Medicare Secondary Payer (MSP), Medicare liability, liens, etc.
• Establishes level of insurance benefits and expected payment for selected services, determines the patient’s portion of payment when applicable, and communicates this to the patient.
• Ensures referrals are obtained and confirms accuracy of the Primary Care Physician (PCP).
• Reviews a variety of reports and records to ensure that referrals and pre‑authorizations from insurance companies have been received.
• Confirms patient eligibility with insurance carriers and obtains visit authorizations as necessary.
• Contacts third‑party payers to obtain pre‑authorizations in accordance with established policies.
• Collaborates with physicians and mid‑level providers to schedule peer‑to‑peer discussions to obtain prior authorization of services denied by the patient’s insurance.
• Coordinates all information for managing insurance denials.
• Collaborates with various Brown University Health personnel to resolve billing issues, prior authorizations, denials, and insurance write‑offs.
• Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.
• Performs other duties as required to support the operations of the department, including, but not limited to, registering patients, scheduling appointments, scanning and faxing documents.

• Knowledge of third‑party coverage, prior authorization process, referrals, etc.; current knowledge of state and federal resources available for needy and disabled, including familiarity with forms and documents necessary to file appeals on denied claims.
• Demonstrated interpersonal skills for effectively communicating with patients, family members, Brown University Health employees, third‑party payers, state and federal representatives, and other government service agencies.
• Ability to operate a computer to access information and to prepare and maintain related records and reports.
• Strong medical terminology knowledge and clear knowledge of Current Procedural…