JOB SUMMARY
The Specialist- Financial Assistance at North Mississippi Health Services is responsible for supporting the overall financial health of the organization by acting as a liason between patients and the hospital, guiding patients through medical costs, insurance, and payment options. The Specialist- Financial Assistance strives to optimize patient financial assistance and reduce bad debt by facilitating clear communication, eligibility checks, payments, and billing accuracy. This role operates under the guidance of the Patient Access Manager and requires an experienced individual with excellent analytical, organizational, and communications skills to review self-pay and underinsured patient accounts, manage demographic and insurance information, interface with patient and care teams to facilitate action and collect information, and maintain records to support a smooth process and optimize payment capture and coverage.
JOB
FUNCTIONS
Patient Experience:
• Obtains crucial confidential patient identification information including patient records, signatures, and payment information repeatedly and ensures HIPAA guidelines are enforced
• Effectively communicates NMHS’ organizational revenue cycle and financial policies including estimates, charity plans and payment options to patients and patient representatives
Patient Financial Assessment & Support
• Meet with patients who are uninsured and have been referred for counseling
• Conduct patient interviews to determine patient demographics, financial status, and risk
• Notify the patient of the final outcome of their financial review
• Explain insurance coverage, expected out-of-pocket expenses, co-pays, deductibles, and non-covered services
• Provide cost estimates for scheduled services (ER, Inpatient, Outpatient, & Surgery)
• Responsible for maintaining Healthcare Coverage Assistance Fund (HCAF) spreadsheet
• Responsible for patient follow up and follow through
Benefits Verification & Authorization
• Verify insurance eligibility, coverage level, and authorizations via systems, provider portals, & payors.
• Coordinate pre-certification and prior authorization in collaboration with central scheduling, patient access, clinical, & billing staff.
Collections & Financial Arrangements:
• Ensures team members are providing estimates to guarantors for procedures and collection attempted at the point of pre-registration or point of service
• Follow up on self-pay balances, missed payments, and aging accounts including calls, letters, notices, and referrals to collections
• Document all patient interactions, payment plans, and financial decisions in the system
• Responsible for check requests and premium payments to insurance
• Ensure payment is received and documented by payor
• Ensures timely and accurate processing of accounts in accordance with best practices, defined workflow, procedures, and applicable legislation/regulations
Financial Aid & Payment Plans:
• Assist with applications for Medicaid, charity care, ACA plans, financial aid, & etc.
• Set up payment plans, collect deposits or cash payments, and negotiate terms based on hospital policies
Contract Management:
• Maintains familiarity with payer methodologies to ensure accurate estimates are communicated with patients & system variances are communicated with leadership
• Manages expected reimbursement to ensure appropriate patient portion is collected prior to service
• Develops strategy for partnering with business office to ensure estimates & transparency are accurate
• Analyzes estimate variances to understand where/why deviations occurred
• Identifies trends and reports potential significant and recurring issues along with possible solutions to leadership
Inter and Outer Departmental Collaboration:
• Work closely with Patient Access, Case Management, Billing, Utilization Review, Social Services, and others
• Generate status reports, flag issues, and escalate to supervisor as needed
• Work in concert with Vendors to ensure Healthcare Coverage Assistance Fund (HCAF) process goes smoothly for NMHS and the patient
Compliance & Policy Adherence:
• Ensure compliance with state/federal regulations, hospital policies, and payer requirements
• Follow up on required third-party documentation and complete necessary filings.
QUALIFICATIONS
Education