Apply on Employer Site

WVU Medicine · 1 month ago

Patient Financial Resolution Advocate

Martinsburg, WV

Full-time

Onsite

Entry Level

2+ years exp

WVU Medicine is a healthcare provider seeking a Patient Financial Resolution Advocate. This role involves interpreting financial policies, assisting patients with financial education, and ensuring financial resolution for accounts while maintaining compliance with regulations.

Health CareHospitalMedical

H1B Sponsor Likely

Responsibilities

Interviews patients who are referred for financial counseling in person or via the telephone to determine financial counseling needs and to help formulate a plan for financial resolution

Uses CPT codes to calculate the estimated procedure cost. Communicates with the patient the anticipated self-pay portion for upcoming services and explores financial resolution options with the patient

Based on information provided by the patient, an initial determination will be made if the patient has adequate benefits or qualifies for Medicaid, special programs or payment arrangements based on federal, state and hospital policy. Refers patients to local, state and/or federal agencies for assistance as needed

Educates patient on their benefits, patient liability and/or the process for applying for Medicaid, completion of the financial assistance application, and payment alternatives

Informs patients of hospital and clinic billing practices/policies and their rights and responsibilities regarding payments

Insured patients who are responsible for a balance after insurance will receive a preliminary financial overview and will be assisted in completion of the financial assistance application if necessary for financial resolution

Reviews completed financial assistance applications and decides eligibility based on hospital policy

Works with specialty departments to establish appropriate financial arrangements for elective services

Identifies and accurately resolves potential patient account issues for WVUHS billing departments

Monitors daily reports to identify large dollar account balances and private pay patient accounts that need resolution

Displays an understanding of third-party payor regulations related to managed care, denials and reimbursement issues

Obtains demographic/billing/insurance information from patient/family/legal guardian and enters in the registration/billing systems for service and claim processing. Obtains and scan patient’s insurance/medical cards and driver’s license into the registration system

Has a working knowledge of current hospital contracts with third-party payors

Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides the patient a receipt and documents payment in the registration/billing systems

Follows up on accounts as indicated by system flags

Balances daily receipts and cash drawer for patient payments, prepares and delivers deposit bag to cashier’s office

Initiates auto accident liability coverage. Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems

Initiates ERSD (end stage renal disease), Veterans Administration eligibility, Black Lung SSI, Workers Compensation, and Medicare Secondary Payer screenings. Updates registration/billing systems as appropriate

Clear accurate documentation of all patient communications and account activities

Uses system software, including online credit card systems

Assists in resolving patient billing questions

Communicates and interacts with clients, families, visitors, physicians, departmental and hospital staff and the public in general in a manner that demonstrates professionalism and concern for the individuals' need(s)

Attends departmental meetings and/or documents review of meeting minutes

Contacts insurance company or employer to determine eligibility and benefits for requested services

Follows up with the patient, insurance company, or provider if there are insurance coverage issues to obtain financial resolution

Assists Patient Financial Services, Patient Access, and Care Management with denial management issues

Communicates problems hindering workflow to management in a timely manner

Prepares WVU Medicine standard consent form, notice of privacy practice and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures. Obtains electronic signature for consent to treat and patient financial obligations

Maintains confidentiality according to policy and HIPAA when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information

Answers phone calls in a professional and courteous manner. Uses phone system in correct manner

Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients, and the public. Ensures compliance by staff to hospital, governmental, and insurance regulations

Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency

Utilizes payer portals and payer websites to verify eligibility

Participates in educational programs to meet mandatory requirements and identified needs regarding professional growth

Research and process mail returns

Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing

Monitors accounts to facilitate timely follow-up for financial resolution

Provides excellent customer service to patients, visitors and employees

Participates in performance improvement initiatives as requested

Obtain Certified Revenue Cycle Representative (CRCR) Certification within 1 year

Qualification

Financial counselingRevenue cycle operationsCPT codingMedical terminologyThird-party payorsCustomer serviceTactDiplomacyWritten communicationOral communicationProblem-solving

Required

High school graduate or equivalent

Demonstrates the ability to assertively pursue necessary information and to function independently to secure financial resolution on accounts

Projects a mature problem-solving attitude while dealing with interpersonal conflict, dissatisfied patients and time demands

Maintains knowledge of revenue cycle operations, third party reimbursement, local/state/federal regulations and medical terminology

Knowledge will include at minimum, all aspect of payer relations, claims adjudication, contractual claims processing and general reimbursement procedures

Uses excellent customer service, written and oral communication skills

Interviews patients who are referred for financial counseling in person or via the telephone to determine financial counseling needs and to help formulate a plan for financial resolution

Uses CPT codes to calculate the estimated procedure cost

Communicates with the patient the anticipated self-pay portion for upcoming services and explores financial resolution options with the patient

Refers patients to local, state and/or federal agencies for assistance as needed

Educates patient on their benefits, patient liability and/or the process for applying for Medicaid, completion of the financial assistance application, and payment alternatives

Informs patients of hospital and clinic billing practices/policies and their rights and responsibilities regarding payments

Reviews completed financial assistance applications and decides eligibility based on hospital policy

Works with specialty departments to establish appropriate financial arrangements for elective services

Identifies and accurately resolves potential patient account issues for WVUHS billing departments

Monitors daily reports to identify large dollar account balances and private pay patient accounts that need resolution

Displays an understanding of third-party payor regulations related to managed care, denials and reimbursement issues

Obtains demographic/billing/insurance information from patient/family/legal guardian and enters in the registration/billing systems for service and claim processing

Obtains and scan patient's insurance/medical cards and driver's license into the registration system

Has a working knowledge of current hospital contracts with third-party payors

Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides the patient a receipt and documents payment in the registration/billing systems

Follows up on accounts as indicated by system flags

Balances daily receipts and cash drawer for patient payments, prepares and delivers deposit bag to cashier's office

Initiates auto accident liability coverage

Identifies all patients involved in an auto accident and obtains all pertinent information regarding medical or non-fault liability and documents in registration/billing systems

Initiates ERSD (end stage renal disease), Veterans Administration eligibility, Black Lung SSI, Workers Compensation, and Medicare Secondary Payer screenings

Updates registration/billing systems as appropriate

Clear accurate documentation of all patient communications and account activities

Uses system software, including online credit card systems

Assists in resolving patient billing questions

Attends departmental meetings and/or documents review of meeting minutes

Contacts insurance company or employer to determine eligibility and benefits for requested services

Follows up with the patient, insurance company, or provider if there are insurance coverage issues to obtain financial resolution

Assists Patient Financial Services, Patient Access, and Care Management with denial management issues

Communicates problems hindering workflow to management in a timely manner

Prepares WVU Medicine standard consent form, notice of privacy practice and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures

Obtains electronic signature for consent to treat and patient financial obligations

Maintains confidentiality according to policy and HIPAA when interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information

Answers phone calls in a professional and courteous manner

Uses phone system in correct manner

Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients, and the public

Ensures compliance by staff to hospital, governmental, and insurance regulations

Organizes and executes daily tasks in appropriate priority to achieve optimal productivity, accountability and efficiency

Utilizes payer portals and payer websites to verify eligibility

Participates in educational programs to meet mandatory requirements and identified needs regarding professional growth

Research and process mail returns

Develops and maintains working knowledge of all federal, state and local regulations pertaining to hospital billing

Monitors accounts to facilitate timely follow-up for financial resolution

Provides excellent customer service to patients, visitors and employees

Participates in performance improvement initiatives as requested

Obtain Certified Revenue Cycle Representative (CRCR) Certification within 1 year

Ability to accurately utilize applicable computer software and equipment for access processing

Demonstrates ability to follow established computer down time procedures

Must have reading and comprehension ability

Must be able to communicate effectively

Must be able to read and write legible in English

Excellent oral and written communication skills

Working knowledge of computers

Basic knowledge of medical terminology

Preferred

Two (2) years of experience in a healthcare setting

Basic knowledge of third-party payors preferred

Basic knowledge of time-of-service collection procedures preferred

Basic knowledge of business math preferred

Basic knowledge of ICD-9 and CPT coding preferred

Company

WVU Medicine

Glassdoor3.6

West Virginia University Health System is a non-profit organization that offers a full range of healthcare services.

Founded in 1898

Morgantown, West Virginia, USA

10001+ employees

https://wvumedicine.org/

H1B Sponsorship

WVU Medicine has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (9)

2024 (11)

2023 (9)

2022 (9)

2021 (7)

2020 (6)