Job Details

Join us at Transformations Care Network (TCN), as we embark on an exciting journey to empower individuals like you to make a difference in the field of behavioral health. We are committed to improving accessibility while raising the standard of care.

The Patient Financial Advocate Lead reports to the Patient Services Manager and serves as a senior-level resource within the Revenue Cycle team, supporting patients with complex billing inquiries, escalated concerns, and individualized payment solutions.

This role requires advanced knowledge of healthcare billing, insurance processing, and financial policies, along with exceptional communication skills and emotional intelligence. The Advocate partners with patients to resolve outstanding balances in a respectful, solution-oriented manner while supporting organizational revenue goals.

Key Responsibilities:

Advanced Account Review and Resolution

• Manage inbound escalations from Patient Services Representatives.
• Conduct detailed account reviews within NextGen PMS to reconcile complex balances.
• Investigate payment discrepancies, insurance processing issues, and posting errors.
• Coordinate with internal RCM, Operations and payer teams when resolution requires cross-functional review.
• Identify trends in recurring patient complaints and recommend workflow improvements
• Process and make recommendations on Financial Hardship Applications

Financial Advocacy and Payment Solutions

• Establish customized payment arrangements within policy guidelines.
• Evaluate hardship considerations and assist patients with financial assistance applications.
• Discuss high-balance accounts with sensitivity and professionalism.
• Support prevention of external collections placement through proactive resolution.
• Guide patients through insurance explanations, appeals guidance (when appropriate), and benefit education

Escalation and De-escalation

• Handle emotionally charged or complex patient interactions with professionalism.
• Apply conflict resolution techniques to maintain trust and positive patient relationships.
• Serve as an escalation point for unresolved complaints before leadership involvement.
• Maintain composure and sound judgment under pressure.

Documentation and Compliance

• Maintain detailed, structured documentation within patient accounts.
• Ensure all payment arrangements and adjustments are clearly noted and policy compliant.
• Follow HIPAA and organizational privacy standards.
• Adhere to internal financial assistance and adjustment policies.

Revenue Impact and Performance

• Support organizational goals related to:
  • Reduction in aging accounts
  • Decrease in external collections referrals
  • Improved payment plan adherence
  • Increased patient satisfaction scores
• Monitor promise-to-pay compliance and initiate follow-up outreach when necessary.
• Participate in QA review and mentor Tier 1 representatives as needed.

Patient Services Center Operations and Dashboard Monitoring

• Monitor daily call center performance metrics including call volume, abandonment rate, average speed to answer (ASA), average handle time (AHT), and service level adherence.
• Identify trends in peak call times and recommend staffing or workflow adjustments to maintain service levels.
• Proactively address elevated abandonment rates or extended hold times by partnering with the Supervisor to implement corrective actions.
• Review call data to identify recurring patient concerns, billing confusion trends, or systemic process gaps.
• Support quality assurance initiatives by correlating performance metrics with call outcomes and patient satisfaction indicators.
• Assist in developing performance improvement plans when dashboard trends indicate service risks.
• Serve as a backup support resource during high-volume periods to ensure service level consistency.

General

• Maintain knowledge of mental health billing, department policies and procedures
• Develop and maintain positive working relationships with cross-functional teams, teammates and Payor representatives and other key stakeholders
• Consistently meet or exceed the department productivity and quality standards and performance requirements
• Collaborate as needed to identify and resolve underpayments and overpayments
• Other duties and responsibilities as assigned including but not limited to:
  • Work overtime with little or no notice as needed
  • Attend team meetings, phone conferences, and training as needed

Qualifications:

• High school diploma or equivalent
• 4+ years experience in healthcare revenue cycle, patient accounts, or medical billing.
• Advanced understanding of insurance processing, EOB interpretation, and patient responsibility.
• Experience handling escalated patient financial conversations.
• Strong system navigation skills
• Demonstrated ability to manage complex accounts independently.
• Intermediate computer skills and proficiency in MS word, excel outlook and database management and internet usage
• 5+ years experience in healthcare revenue cycle and patient account management (Preferred)
• Prior call center or high-volume inbound call experience. (Preferred)
• Advanced understanding of insurance processing, EOB interpretation, and patient responsibility. (Preferred)
• Experience handling escalated patient financial conversations. (Preferred)
• Strong system navigation skills (NextGen PMS experience preferred). (Preferred)
• Demonstrated ability to manage complex accounts independently. (Preferred)
• Certified Revenue Cycle Representative or other billing certification (Preferred)

Core Competencies

• Advanced communication and negotiation skills
• Emotional intelligence and empathy
• Analytical problem-solving
• Attention to detail
• Accountability and ownership
• Cross-functional collaboration
• Professional judgment and discretion

Explore the Advantages of Joining Our Team:

• Enjoy competitive compensation and a wide range of benefits, including medical, dental, vision, low-cost virtual care, dependent and domestic partner coverage, 401K, and more, designed to support your well-being and financial security.
• Immerse yourself in a community united by a deep commitment to enhance mental health and revolutionize patient care.
• Embrace a journey of continuous learning, guided by seasoned professionals, fostering your career growth in a nurturing environment.
• Play a pivotal role in reshaping behavioral health, with your efforts directly improving patient lives.
• Thrive in an environment that celebrates collaborative success, driven by effective communication and unity.
• Receive comprehensive onboarding and ongoing educational resources, tailored to cultivate your talents and assure your triumph in your role.

Transformations Care Network is committed to fair and equitable compensation practices. The hourly compensation range for this role is $23 - $26. Actual compensation may vary based on licensure, experience, market-driven enhancements, and incentive opportunities available for this role. These ranges represent our current standard compensation practices and may be adjusted over time to remain competitive and aligned with organizational needs.

Transformations Care Network is an equal opportunity employer, committed to fostering an inclusive and diverse workplace.