The PFC/CAC assesses patients’ financial and insurance information in order to determine Medicaid, Marketplace, or other Community Programs or Resources. Assists with the actual insurance enrollment processes. Manages accounts that require a detailed, large scope analysis of payment/insurance options in order to secure reimbursement. Handles active, unbilled, self-pay and high dollar inpatient and outpatient accounts. Receives account referrals from Pre-access Department, Utilization Review Staff, Patient Access Staff, Physicians, Central Business Office Managers and others for high deductible, out-of-pocket expenses, unresolved or pending claims, out-of-network procedures and other financial risk issues. Counsels patients that have previous debt, with poor payment history, are unresponsive or uncooperative in implementing appropriate payment solutions.

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.  

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.  Here are just a few:      

• Expect paid time off, parental leave, 401K matching and an employee recognition program.   

• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.  

• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.   

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.   

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. 

Find a fulfilling career and make a difference with UnityPoint Health.

• Each day obtains work by referral and by accessing Epic, work queues, reports and daily house census.
• Counsels patients via phone or in person, reviews patient’s previous accounts for outstanding balances, and financially counsels them on all options of payments.
• Monitors and works, on a daily basis, all the self-pay accounts from the assigned work queues.
• Assess patient’s financial/insurance information in order to determine insurance eligibility.
• Gather financial data to complete initial assessment.
• Follow up with Department of Human Services and all other Public Agencies regarding application progress.
• Reviews Department of Human Services decisions for enrollment in applicable states.
• Ensure that all follow-up with the Department of Human Services has been completed for and by the patient.
• Assess patient/consumers for other Community Assistance Agencies.
• Ensure that all options have been exhausted, prior to the patient qualifying for Financial Assistance.
• Tracks financial impact of PFC/CAC Program.
• Works closely with the CBO to ensure that there is cohesiveness of processes and no duplication of efforts.
• Communicates effectively with Case Managers to impact their plan of care.
• Educate patients, employees and physicians regarding Medicaid and Marketplace place insurances that may be available.
• Possesses excellent time management skills to ensure that patients being discharged are counseled, prior to handling other less “time sensitive” responsibilities.
• Maintains billing and collection tracking spreadsheets that captures patients and account disposition/resolution.
• Completes and submits Medicaid and/or ACA Applications for patients that may potentially qualify in a timely and accurate manner.
• Educates consumers/patients on Quality Health Plans, deductible, out-of-pocket, government subsidies, etc.
• Maintains, extensive and current, knowledge of Marketplace plans with Iowa and if appropriate Illinois, Nebraska, Wisconsin exchanges.
• Completes annual CAC Training for UPH as well as CMS. Displays all Certificates, at all times, when assisting consumers in office or in person.
• Provides fair, impartial, accurate information to assist consumers when submitting the eligibility application.
• Assists Registration in maintaining a working knowledge of a patients Medicare life time reserve days. Educates the patient and obtains a consent form regarding their options.
• Calculates and/or estimates expected charges, third party payor portion and patient portion.
• Communicates insurance coverage and patient liability portions to patients or representatives.
• Explains to hospital credit and collection policies, payment options and refers to Cashiers for account negotiations.
• Assists patients in completing UPH Financial Assistance Application if necessary. And, Forwards all appropriate documents to the CBO.
• Documents actions in all appropriate computer systems. Documentation must be thorough and include current account disposition and direction of future activities.
• Performs follow-up and maintains all assigned work que accounts.
• Updates patient insurance information in Epic as new data is received and communicates changes to appropriate parties.
• Facilitates Cobra account appropriateness.

EDUCATION:  High school graduate or GED equivalent is required.

EXPERIENCE: One year previous experience in Patient Access or Billing required with demonstrated competency working with third party payers to meet notification and pre-cert requirements.   Knowledge of third party payer processes and billing procedures required.  Must have experience using computer based software including word, excel and access data bases, minimum typing of 40 wpm. Accurate data entry with numbers, letters and the ability to spell medical terms correctly is required. Previous customer service is desired, but all staff members must have the ability to work with all age groups in a professional and positive manner.

LICENSES/CERTIFICATIONS: Obtains MarketPlace certification within 6 months of employment and maintains this certification while in the position. Obtains Medicaid Presumptive certification with 3 months of employment and maintains this certification while in this position. Medical Terminology