Financial Family Medicaid Advocate

Nemours is looking for a compassionate, detail‑oriented Financial Family Medicaid Specialist Advocate  to support families as they navigate the financial side of their care. Applicants must have hospital based financial counseling/Medicaid enrollment experience to be considered. 

Utilizing high-level customer service, healthcare finance knowledge, and excellent communication skills, the Financial Family Advocate will facilitate, educate, and communicate to patients/families about the financial aspects of seeking treatment at Nemours. Work involves conducting face-to-face interviews, gathering, assembling, and reviewing sensitive information supplied by applicants, relevant to the initial and on-going Nemours Financial Assistance and Medicaid Programs. 

The Financial Family Advocate will work directly with insurance carriers or with internal insurance verification personnel to determine benefit level, coordination of benefits, coinsurance and deductible amounts and communicate financial obligations to the guarantor. This role will be responsible for determining a suitable financial assistance program for each family identified as being in need, developing payment arrangements and collecting payments on patient responsibility balances  In addition to providing financial assistance and resources, the Family Financial Advocate will research and address a broad range of inquiries covering items such as insurance regulation and processing protocols, charge discrepancies, benefit interpretation and claims adjudication. This role is also responsible for supporting the Medicaid Enrollment processes with DE/PA/NJ Medicaid programs. The role may require some travel to other Nemours locations to assist with the Financial Services processes and education.

Schedule: Monday- Friday 8-4:30PM

Responsibilities: 

Customer Service:   Convey courtesy, dignity, respect and a positive attitude through words and actions to establish harmonious relationships with all individuals.   Demonstrate effective communication and respect by using active listening skills, positive body language and effective verbal, written and electronic forms of communication. Demonstrate care and concern and inclusion when interacting with and informing customers by consistently using A.I.D.E.T and protecting confidentiality and privacy.       

1. Utilize daily work queues, reports and schedules to identify and make contact with underinsured/uninsured patients to assist them in meeting their financial obligations for care by applying internal policies/procedures and external resources-such as Medicaid programs.                                     
2. Interview patients/families to obtain comprehensive financial information and based on this information, advise them on available financial assistance/Medicaid programs and assist them with applications and/or enrollments. 
3. Respond timely and appropriately to all internal referral requests and external customer phone calls to ensure that all issues are resolved in accordance with departmental standard workflows. This includes but is not limited to- billing inquiries, charity care applications, payment plan requests, accounts requiring special consideration, researching high dollar and newborn accounts. 
4. Collaborate with Authorization and Patient Cost Estimate teams to promptly identify self-pay patients, patients with high out of pocket expenses or with a non-contracted insurance carrier.
5. Meet daily/weekly/monthly goals and expectations:  call center metrics and recording evaluations, accurate payment posting, self-pay screening and account follow up guidelines, and account documentation.
6. Ensure that payment plans, discounts, special services funding, charity care, and receipt of payments are accurately assigned to accounts, properly documented and reconciled daily.
7. Coordinate with insurance carriers to verify eligibility and determine healthcare benefits particularly as it relates to out-of-pocket expenses for the patient and/or patient’s family and confirm that documented information is accurate and current, including demographic information.

Qualifications:

• Associates degree or 1 year of specialized training beyond high school required 
• CHAA (Certified Healthcare Access Associate), CRCR (Certified Revenue Cycle Representative) or CAC  (Certified Application Counselor) preferred 
• Minimal of 3 years of relevant work experience required
• Hospital based financial counseling/Medicaid enrollment experience required