Financial Advocate

Why ThedaCare?

Living A Life Inspired!

Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world.

At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility. A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness –

• Lifestyle Engagement
  • e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support

• Access & Affordability
  • e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!

Summary :

The Financial Advocate for Wound and Ostomy supports the ThedaCare Wound patients, providers and staff at the following ThedaCare locations; ThedaCare Berlin location, (TCB), ThedaCare New London (TCNL), Thedacare Waupaca (TCW), ThedaCare Shawano (TCS), ThedaCare Appleton (TCA), and ThedaCare Neenah (TCN). The Financial Advocate is responsible for verifying patient insurance eligibility and coverage and securing third party payer authorization for services to be rendered for all TC locations where Wound and Ostomy care is rendered, performs scheduling and registration, while meeting the mission, vision, and goals of ThedaCare and regulatory compliance requirements.

Job Description:

Key Accountabilities

• Completes accurate and timely insurance verification.
• Completes accurate and timely third-party payer authorization requests, including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes) are available.
• Ensures services scheduled by outside providers have approved authorization as required by payer and procedure prior to service.
• Communicates with patients, insurers, and other appropriate parties pertaining to insurance verification and authorization.
• Refers underinsured/uninsured patients and/or point-of-service pre-payment required services to the Pre-Service Patient Financial Responsibility and/or Financial Assistance team(s) to determine if the patient is eligible for assistance and obtain payment prior to services being received, when applicable, to help manage the organizations bad debt.
• Creates a positive patient experience by being polite, compassionate, and professional.
• Provides cross-coverage and training, when needed, for other team members.
• Schedules and pre-registers patients using appropriate procedures based on provider orders.
• Provides proper patient instructions while providing excellent customer service as measured by Press Ganey.
• Facilitates the flow of patient forms, patient letters, and data collection per department needs.
• Collects and enters all necessary demographic, clinical, billing, and insurance information from customers or responsible parties to facilitate a seamless customer experience.
• Explains general consent for treatment forms to the patient/guarantor/legal guardian, and obtains necessary signatures. Explains and distributes patient education documents.
• Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code. Enters benefit data to support point-of service collections and billing processes to assist with a clean claim rate.
• Screens medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare. Distributes and documents other forms and pamphlets.
• Performs other duties as assigned including answering the phones at other facilities.

Qualifications

• High School diploma or GED preferred.
• Must be 18 years of age.
• Ability to work in fast paced and dynamic environment
• Independent and able to manage multiple tasks
• Team-oriented to keep productive, efficient, and on-task
• Strong verbal, written, and communication skills with the ability to clearly communicate technical subject matter to a wide range of audiences
• Desire and ability to learn new skills and assume new responsibilities
• Working knowledge of Microsoft Office products including Word and Excel

Education

• High Scool or GED preferred

Experience

• Two years’ experience in a medical business office or health care setting involving customer service or patient-facing responsibilities, or equivalent experience.
• Prior Epic experience preferred

Physical Demands

• Ability to move freely (standing, stooping, walking, bending, pushing and pulling) and lift up to a maximum of twenty-five (25) pounds without assistance
• Job classification is not exposed to blood borne pathogens (blood or bodily fluids) while performing job duties

Work Environment

• Climate controlled office setting with daily movement throughout the facility
• Interaction with department members and other healthcare providers
• Use of computers throughout work day
• Frequent use of keyboard with repetitive motion of hands, wrist and fingers

Scheduled Weekly Hours:

40

Scheduled FTE:

1

Location:

ThedaCare Medical Center - Waupaca - Waupaca,Wisconsin

Overtime Exempt:

No