Financial Counselor Outreach Advocate
This position coordinates with the Outreach & Enrollment team and other community resources and supports to optimize outcomes, collaborates with the insurance companies, patients, and patient guarantors to ensure the qualified insurance has been properly billed & expected payments received. This position reviews the results from the O&EC team to bill insurance companies, works with the patient to create payment plans, will track Special Programs for patients qualified, review insurance rejections on behalf of patient, and will review patient questions or issues.
A Day in the Life
This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

• The Financial Counselor Outreach Advocate is expected to provide the following services to patients, applicants, qualified individuals, enrollees, qualified employees, and qualified employers, and/or these individuals' legal representative(s) or Authorized representatives.

Communicating with the O&E team on insurance support.

• Confirming insurance is active on dos; attaching to encounter; billing claim; following up on claims.
• Work with O&E team & partners to identify uninsured OB patients to follow-up with AEMA insurance, attach, and bill to insurance.
• Follow-up on O&E billed/balance report on outstanding balances & claims not paid.
• Assist O&E team with patients as necessary

Insurance Denials

• Denials for date of birth or name mismatches - contact patients for insurance updates and corrections.
• Work with patients on other insurance denials.
• Follow through with patient inquiries, requests, and complaints. Forwards difficult and non-routine inquiries or requests to the appropriate level for resolution.

Spanish Community

• Review appointments at SBHCs for uninsured Spanish speaking parents &/or their children if none associated with the school-based patient.
• Link Spanish speaking patients to O&E team and assist as necessary.
• Prepare Spanish pamphlets for SBHC events, and O&EC services.

Special Programs

• Tracking special programs.
• Sending claims to specific programs if requested.

Patient Balances

• Contacting patients via email, written correspondence, or telephone to inform them of overdue balances.
• Developing suitable payment plans for patients based on their monthly income and financial obligations.
• Initiating payment collection processes, if applicable
• Complete adjustment form w/approval, scan into patient's records, and record adjustment on patient encounter, if required.

Front End Quality Support

• Periodic Sliding Fee audits, and other audits as requested.
• Identify incorrect PSR processing trends and escalate as appropriate.
• Assist with PSR training, if applicable.

Community Engagement

• o Attending on-site/off-site community engagement activities, clinic events, and/or training as needed.
• o Assist with Marketing brochures for outreach events.

Standards

• Provide information in a fair, accurate, and impartial manner.
• Maintains complete & accurate patient assistance files.
• Scans signed financial obligations & other pertinent information into the patient files.
• Permitted to create, collect, disclose, access, maintain, store, or use Personally Identifiable Information (PII) from consumers.

Core Competencies

• Customer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met.
• Communication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills.
• Dependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements.
• Quality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.
• Productivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow.

Requirements
Success Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience
Medical Software experience required; Next Gen software preferred. Billing experience preferred. High School education or similar experience.
Language Skills
Must be Bi-lingual. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of an organization.
Reasoning Ability
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills
To perform this job successfully, an individual should have the ability to gain knowledge of current practice management system, electronic medical record, Microsoft Word, text paging, Internet, and Intranet.
Certificates, Licenses, Registrations
None
Other Applicable Requirements
Ability to speak English & Spanish. Knowledge of medical billing software applications.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to stand, walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is occasionally exposed to fumes or airborne particles; toxic or caustic chemicals and risk of radiation. The noise level in the work environment is usually moderate.
Affirmative Action/EEO Statement
It is the policy of Primary Health Solutions to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information, or any other protected characteristic under applicable law.
Other Duties as assigned.