Zulma Mejia Jimenez

The Patient Financial Advocate is responsible for screening patients on-site at hospitals for eligibility assistance programs either bedside or in the Emergency Room Department. This includes providing information and reports to client contact(s), keeping them current on our progress.

Essential Duties and Responsibilities:

Review the hospital census or utilize established referral method to identify self-pay patients consistently throughout the day.

Screen those patients that are referred to Firstsource for State, County and/or Federal eligibility assistance programs.

Document the results of the screening in the onsite tracking tool and hospital computer system.

Face to face screen patients on site as able. Attempts to reach patient by telephone if unable to screen face to face.

Outside field work as required to include Patient home visits to screen for eligibility of State, County, and Federal programs.

Other Duties as assigned or required by client contract.

• Create claims for submission to insurance carriers
• Follow up on unpaid or underpaid claims
• Working denied and aging insurance claims
• Maintain patient information and financial records using account software
• Handle patient account inquiry and provide resolutions
• Communicate directly with different clinics
• Provide outstanding customer service to patients, physicians, and clinic staff
• Promote a positive, professional image of the organization
• Accounts receivable and more.

• Certified as CAC for Marketplace Enrollments
• Assist Reviews patient schedules to identify and meet with patients with upcoming appointments who need assessed for potential financial assistance for potential financial assistance, potential payer sources to identify additional available benefits
• Meets with Patients to identify relevant financial assistance and /or payer sources and identifies additional available benefits for Medical
• This includes screening services within Primary Health Care
• Assists patients in fully completing the necessary application and paperwork or electronic presumptive Medicaid application
• On a wide range of support issues.

• Accomplish Corporate Business Objectives by providing contact center customers with high quality, courteous and accurate technical information and support in a timely, efficient and professional manner
• The primary focus is on one-to-one customer interaction via telephone, e-mail or chat, exercising sound judgment and initiative in following established policies and procedures, and working independently on a wide range of support issues.

• Processed medical claims (paid, denied, and adjusted—INP, OP, UB '92, HCFA 500) using knowledge of CPT codes and ICD codes
• Reviewed authorizations and referrals with hospital business offices
• Knowledge of adjudicating Medicare, Commercial and Individual Claims
• Reviewed hospital contracts to make sure claim was processed correctly
• Trained Claims Adjusters for medical claims
• Audited and adjusted claims from error reports
• Process contract and non-contract claims in an accurate and timely manner meeting department, HFCA and company guidelines for quantity and turnaround time accuracy and generated correspondence to request missing information necessary to complete claims payments
• Determined level of reimbursement based on established criteria, Provider Contract, Medicare rates, plan and Employer Group provisions
• Rejected all claims ineligible for payment according to Medicare / ACFA rules and regulations.