Financial Services Advocate

OVERVIEW

Serves as the primary resource for assisting and determining financial assistance opportunities for BTNRH patients and families before, during, and after their care delivery. Provides care estimations, financial assistance, payment plans, and enrollment in government healthcare programs.

SCHEDULE

Monday‑Friday 8:00 a.m. – 4:30 p.m. or 8:30 a.m. – 5:00 p.m. In‑Office.

MAJOR RESPONSIBILITIES & DUTIES

Assist patients and/or guardians in determining an estimate for cost of services by conducting a financial screening and anticipating out‑of‑pocket liability, including co‑payments, coinsurance, deductible, and non‑covered or self‑pay service charges prior to their visit or rendering of service using resources such as payor websites, employer benefit departments, servicing provider representatives, internal electronic medical record systems, and charging source systems. Communicate and collect estimated out‑of‑pocket liabilities in advance of services, counsel appropriate parties with available options, enroll in governmental programs, set up payment plans, and complete the full application process for BTNRH Financial Assistance based on current income levels, lifetime maximum benefit levels, and catastrophic medical needs. Screen patients for potential secondary Medicaid eligibility, enrolling them in NE Medicaid or independent state agency Medicaid applications and ensuring proper documentation for approval. Work all Certificate of Billing (COB) denials from Medicaid & Managed Care Medicaid, contacting patients/guardians to identify other active commercial coverage, gathering pertinent information, updating Epic, and ensuring new primary claims are submitted in the correct filing order. Complete pre‑collection calls to assist patients in determining an acceptable payment plan, qualify for financial assistance, or identify Medicaid/ government agency healthcare program eligibility, thus minimizing outsourcing accounts to a third‑party collection agency. Review all bankruptcy notices and handle necessary adjustments to remain compliant with bankruptcy laws and regulations. Review clinic schedules for opportunities regarding no coverage, high‑dollar visits or new patients missing necessary insurance information that can be obtained prior to the date of visit and services rendered. Refer patients to the appropriate SSI office to apply for disability when conditions warrant such assistance. Maintain summary data to report quarterly or as needed, to recap activities, time, and expenses related to filing financial assistance applications, Medicaid application processing, community resource referrals (CHIPS, COBRA), and collection efforts. Serve as liaison between patients, referral sources (e.g., Customer Service, Social Work, Registration, Physicians, Hospital, and ancillary service lines), BTNRH Patient Financial Services, and clinical operations to explain charges and offer payment options or outside‑agency resources. Perform annual review and updating of policy and procedures related to financial assistance guidelines and practices. Check pending Medicaid applications daily; at approval, review patient encounters and account information, update coverage, alert pre‑certification and/or utilization review nursing team for admitted or pending admission status, and flag accounts for claims processing. For denied applications, determine cause of denial and assess eligibility for financial assistance or appropriate payment options. Perform monthly checks during the first week of each month of all in‑house NE & IA Medicaid patients and any scheduled surgeries in the current month that were previously eligible for the prior month, updating affected systems and notifying parties for billing, authorization, and discharge planning. Assist patients in contacting insurance companies regarding benefits, coverage, and payment liability for services, proactively or in dispute of existing charges. Perform proactive review of all self‑pay accounts scheduled for services at BTNRH clinics or currently admitted to the facility that may involve high‑dollar services or lengthened stays prior to discharge. Act as liaison between BTNRH and the States of IA and NE Departments of Health and Human Services to remain informed of policies, guidelines, and updates; annually coordinate and attend on‑site informational meetings with state representatives. Provide timely communication updates to leadership, compliance, and marketing as needed to ensure compliance and accuracy of marketing materials. Annually review and update federal poverty guidelines based on federally driven standards.

KNOWLEDGE, SKILLS, AND ABILITIES

Apply thorough knowledge of ICD‑9‑CM, HCPCS/CPT coding theory, medical terminology, disease processes, and anatomy/physiology as they relate to patient services and liabilities. Type at least 30 words per minute with at least 90 % accuracy and perform arithmetic calculations. Maintain current and accurate records with meaningful summaries. Treat information in patient records with strict confidentiality. Communicate effectively, both written and orally, de‑escalating stressful situations while maintaining a positive and professional demeanor. Interpret insurance contracts and benefits. Apply working knowledge of 1500 and UB04 billing. Possess excellent interpersonal skills, close attention to detail, critical thinking, and organizational skills.

REQUIRED QUALIFICATIONS

High school diploma or equivalent mandatory. Minimum of 5 years of experience in healthcare, with a focus on collections, follow‑up, or customer service. Knowledge of medical insurances (Medicare, Medicaid, PPO, HSA plans, and Commercial), EMTALA regulations, hospital and professional billing services, and collection processes required.

PREFERRED QUALIFICATIONS

Associate degree or post‑secondary education in Business, Healthcare, Finance, or Customer Service preferred. Experience working in an Electronic Medical Record preferred.

PHYSICAL REQUIREMENTS & EQUIPMENT USAGE

Position is largely sedentary in a normal office environment. Use of office equipment such as computer/laptop, monitor, keyboard, and general workstation set‑up required.

OTHER DUTIES

This job description incorporates the essential functions and duties required for this position. Other duties may be assigned as needed and determined by a supervisor.

BENEFITS

Boys Town offers a comprehensive benefits package that includes medical, dental, and vision coverage; a 401(k) plan with company match; tuition reimbursement; parenting resources; mental health services; and other employee‑focused programs.

EEO STATEMENT

Boys Town is an equal employment opportunity employer and participates in the E‑Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability‑related accommodation in the application process, contact us at View phone number on click.appcast.io. #J-18808-Ljbffr Boys Town