Patient Financial Navigator

Job Type: Regular

Time Type: Full time

Work Shift: Day (United States of America)

FLSA Status: Non-Exempt

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

Under the direct supervision of the Supervisor of Financial Counseling and leadership of the Manager of Financial Counseling, the Patient Financial Navigator acts as a liaison for patients to the health system; providing guidance and support for all financial components of healthcare; specifically focusing on billing concerns, understanding insurance options and benefits, gaps in coverage, and payment options. Additionally, the Patient Financial Navigator provides assistance with patient statements, payment plans, pricing estimates, Financial Assistance, Federal/State benefits, and the managed care process. This position supports Patient Access and both Hospital and Professional Billing areas and works in conjunction with Customer Service.

Job Description:

Essential Duties & Responsibilities including but not limited to:

• Maintains annual Certified Application Counselor certification for the state of Massachusetts.

• Assists over the phone or in person to address financial matters or concerns; discusses and documents any issues resulting from collection notices, statements, and/or other billing and insurance issues.

• Responsible for helping patients understand their Explanation of Benefits (EOB) including insurance policies and covered services.

• Works with departments and providers throughout the organization to ensure resolution of patient financial concerns; this includes elective, plastic, and/or low coverage or non-covered medically urgent procedure.

• Helps coordinate services with outside stakeholders to provide necessary coverage for patients that require an enhanced coordination of benefits due to disabilities.

• Follows established protocols ensuring appropriate financial counseling actions have been taken and communicates back to the department prior to scheduling procedures that will not be covered by insurance. This includes elective, plastic, and/or low coverage or non-covered medically urgent procedures.

• Assists with providing timely estimates for services to patients (either orally or in writing) in compliance with CMS price transparency regulations.

• Collects payments for self-pay patients: pre-payments and outstanding balances including copayment and deductibles, and out of pocket expenses in accordance with PFS policy and procedures.

• Follows guidelines set forth by leadership to educate and enroll qualified patients in payment plans for outstanding or anticipated balances.

• Screens and approves patients for Financial Assistance (Charity) by following Financial Assistance Policy guidelines.

• Visits patients who are inpatient or in the outpatient clinics, when appropriate, to discuss coverage applications and payment options.

• Supports patients with Masshealth/Medicaid Open Enrollment; providing education and processing necessary applications.

• Addresses Managed Care concerns with patients who require assistance.

• Works directly with Customer Service for resolution of financial issues including account adjustments, statement generation, or billing errors.

• Works on projects as assigned.

• Adheres to all corporate and governmental compliance issues as directed.

• Complies with all Cash and Collection Policies and Procedures.

• Adheres to our Customer Service standards to provide exceptional patient service.

Education: High School Diploma required

Licensure, Certification & Registration: CAC Certification preferred. CPC Certification a plus.

Experience:

• Excellent customer service skills.

• Excellent written and oral communication and interpersonal skills required.

• Must exhibit tact, diplomacy and discretion at all times.

• Must be able to multi-task and work in a fast-paced, detail oriented environment.

• Working knowledge of MS office suite and database systems with the ability to learn new systems as they become available.

• In the absence of any of these skills, must demonstrate the ability to be thoroughly trained to meet organizational standards.

Skills, Knowledge & Abilities:

• 2-3 years experience in a Financial Counseling, Social Work, Case Work, Patient Access or Billing field preferred and a general understanding of hospital and professional billing procedures.
• EPIC system experience preferred.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment.