This position will perform Quality Reviews on applications, insurance verifications and notifications of admission completed by each specialist in the PFA Department for completeness and accuracy. These reviews will occur periodically at random and on all cases denied to ensure we have not missed opportunities due to timelines or inaccurate processing. The Sr. Financial Assistance Specialist will report results of the quality reviews regularly to the Manager of the Patient Financial Assistance department.
Additionally the Sr. Financial Assistance Specialist will support the department by training staff, answering questions as needed, and monitoring workflows on a regular basis.
This position will also be a working lead and will perform full Financial Specialist functions on applications for federal, state and county programs, Medical Financial Hardship (MFH), insurance verification and notification of admission for Renown. The responsibilities of the Sr Financial Assistance Specialist includes but is not limited to the following:
Facilitate the application process for financial assistance with all applicable and appropriate patients including pre-admission, bedside visits while in-house, and follow up after discharge through on site or field visits.
Follow up with patients to obtain all supporting documentation for each application process.
Maintain documentation on all work activity for each patient account in the appropriate systems.
Maintain communication/correspondence with patients, representatives, designated family members, appropriate Renown staff and all government entities on all accounts served.
Completes application summary forms for FAP Committee review and presentation.
Monitors all cases processed for financial assistance and by the FAP Committee to completion.
Completes documentation to justify adjustments for processing by the Central Business Office.
Issues all decision letters to patients who apply forFAP.
Ensures all patient co pay balances are collected as a result of the FAP approval process.
Accurately identify all insurance payer sources and payer order sequence
Verification of insurance eligibility and benefits
Timely insurance notification
Determining estimated cost of services being rendered
Identifying and collecting patient financial obligation amounts, i.e. co-payments, co-insurance, deductibles, etc.
Provides weekly report of application, verification and notificationdiscrepancies by PFA representative to departmental leadership to be utilized for training purposes.
Reports trends identified during QA processes to department leadership to ensure maximization of reimbursement.
Participates in development and deployment of department training modules resulting from QA activities.
Nature and Scope:
This position is responsible to conduct quality reviews of applications in addition to comprehensive financial screenings as directed. These may be conducted in person or by telephone interview, to identify all potential payer sources including federal, state and county assistance programs, and follow through with obtaining and processing the appropriate application(s) in a timely manner. Whenever possible, the screening will be done prior to admission. The employee is responsible to ensure this process is expeditious, compassionate and patient friendly. This position is accountable for timely coordination and accurate communication of information relative to all aspects of the financial assistance process, and for timely submission of applications to the appropriate government entity.
This position will review applications, verifications and notifications that are delayed or denied for appropriate processing and education to ensure that accounts are financially secured and reviewed avoiding any lost reimbursement to the health system. The employee must use diplomacy in communicating effectively to patients, guardians, family members, physicians and co-workers. In addition, the employee is responsible to coordinate with the interdisciplinary team, i.e. Case Management, Social Services, Nursing, etc. to ensure a seamless admission and discharge process occurs for all patients referred to the department. This position is responsible to always exhibit the highest level of professionalism in accordance with Renown Health's Values.
This position collects data regarding the accuracy and completeness of all applications made by the PFA department to be used for employee education purposes and to maximize reimbursement to the health system. The employee will participate in the training process, and will provide reporting to departmental leadership.
This position does not provide patient care.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Requirements - Required and/or Preferred
Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor's degree preferred. Bilingual candidates (Spanish) will be given preference. Requires the ability to perform intermediate math skills. Understanding of medical terminology. Annual continuing education requirements exist for this position.
Requires, at a minimum, to have two years experience in commercial medical insurance benefits and eligibility verification, Medicaid screening, applications and/or eligibility, medical financial counseling experience, medical claims processing knowledge, hospital Business Office follow-up experience, and/or professional office with customer service financial interaction experience. Experience in an acute care hospital preferred.
Valid State of Nevada or California driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria.
Nevada Division of Insurance Exchange Enrollment Facilitator Certification required. Nevada DWSS Hospital Presumptive Eligibility Certification required.
Computer / Typing:
Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Thorough knowledge and proficiency with MSExcel and MSWord. Experience with EPIC system preferred.