Patient Financial Advocate

Overview

Patient Financial Advocate (Healthcare)

The Patient Financial Advocate, under the general direction of the Director of Financial Support Services, works collaboratively with patients, family members, team members, and other departments to assist, optimize, coordinate, and clarify opportunities to help patients understand and cover healthcare costs. The role focuses on helping patients understand and optimize health insurance coverage, external assistance programs, and government assistance programs. The core responsibility is to ensure that all patients are able to receive world-class care and that options are exhausted to help reduce financial toxicity while ensuring CARTI can collect for services provided.

The role also includes providing patients and families with a clear overview of treatment costs, acting as the patient’s direct point of contact for all insurance and billing inquiries, and ensuring patients have resources and information to make and maintain appointments with a clear understanding of financial implications and coverage options. The mission is to provide caring and compassionate care, while demonstrating empathy, to all CARTI patients, families, and team members.

The Patient Financial Advocate will advocate for CARTI patients while protecting CARTI’s financial interests.

• Provides excellent customer service to patients remotely and in-person on a daily basis.
• Works with patients to understand and optimize health insurance and supplemental coverage options for medical and pharmacy benefits.
• Collaborates with Provider and Nursing Staff to proactively assist with investigating, attaining, and activating patient financial assistance for medications dispensed from a pharmacy; completes new and renewal applications and communicates with patients to activate financial assistance options.
• Works with the Social Work Team Lead to proactively assist with investigating, attaining, and activating patient financial assistance options available through external entities and internal grants/foundation.
• Serves as a subject matter expert on the Patient Financial Advocate Team for all patient assistance programs (including those managed by Social Work, Physician Dispensing, and Oral Oncology departments/units).
• Provides patients and families with a clear overview of their treatment costs (pre-estimates).
• Identifies, determines eligibility, and enrolls patients into available co-pay, foundation, pharmaceutical assistance programs, and other patient assistance programs.
• Assists patients with enrolling in Medicaid and other government-sponsored healthcare assistance programs.
• Acts as the patient’s direct primary point of contact for all insurance and billing inquiries.
• Determines patient responsibility and performs appropriate point-of-service collection; collects payments due on accounts; enrolls patients in payment plan arrangements.
• Verifies current insurance coverage, including out-of-pocket costs, deductibles, and/or coinsurance as necessary.
• Coordinates the financial aspects of a patient’s care with Medical Providers, Third-Party Payors, Business Office Team Members, Social Workers, and other CARTI departments.
• Reviews patient accounts for deficiencies and errors, and coordinates corrections with other departments as necessary.
• Identifies and contacts billing regarding delinquent CPA accounts according to collection guidelines and policies.
• Assists patients with completing and validating applications for government-sponsored healthcare programs, patient assistance programs, CARTI patient assistance programs, and other hardship relief or assistance programs; coordinates the application process until completion.
• Requests correct/updated information from patients and communicates issues to Management in a timely fashion.
• Acts as a liaison to assist patients with navigating internal processes or resolving inquiries, concerns, or complaints.
• Performs telephone communications with patients and reviews provider schedules and accounts for high patient and insurance balances, coordinating with the billing team as needed for follow-up.
• Reviews patient chemotherapy protocols to determine…