Job Overview
The Lead Patient Financial Advocate (Lead PFA) - Home Infusion Business Office provides advanced financial counseling and serves as a subject matter expert and team lead within Patient Financial Services. This role supports complex patient cases, ensures high-quality financial advocacy practices, and assists in overseeing daily operations of the team. The Lead PFA partners closely with clinical, operational, and revenue cycle leadership to optimize patient experience, reduce financial barriers, and improve reimbursement outcomes. This role will provide services for management of Fairview Homes Infusion as well as external customers. This includes consulting and training services for external consulting engagements.
Responsibilities
- Leadership & Team Support - Serve as a resource and mentor to Patient Financial Advocates, providing guidance on complex cases and payer scenarios - Assist with onboarding, training, and ongoing competency development of team members - Support daily workflow management, work queue prioritization, and productivity oversight - Act as escalation point for challenging patient financial situations or payer issues - Collaborate with leadership on performance improvement, quality assurance, and process optimization initiatives
- Advanced Financial Counseling - Provide in-depth financial counseling for patients with complex therapies or high-cost treatments - Deliver detailed cost estimates and explain patient financial responsibility, benefits, and coverage limitations - Facilitate patient understanding of billing processes, payment expectations, and funding options
- Insurance & Reimbursement Expertise - Conduct or oversee complex insurance verification and benefits investigation (commercial, Medicare, Medicaid) - Interpret payer policies, prior authorization requirements, and reimbursement guidelines - Identify risk areas related to coverage or denials and proactively communicate mitigation strategies
- Financial Assistance & Advocacy - Lead efforts to identify and secure financial assistance for patients (e.g., manufacturer programs, grants, copay assistance, charity care) - Support escalated cases involving payer disputes or financial hardship - Advocate for patients by collaborating with payers, internal departments, and external funding organizations
- Quality, Compliance & Reporting - Ensure adherence to organizational policies, payer regulations, and HIPAA compliance - Perform quality audits of team documentation and patient interactions - Track and report key metrics (e.g., authorization success, patient assistance secured, patient satisfaction) - Identify trends and recommend process improvements to enhance financial outcomes and patient experience
- Cross-Functional Collaboration - Partner with intake, clinical, case management, billing, and collections teams to ensure seamless financial coordination - Collaborate with leadership to develop standardized workflows and best practices - Participate in strategic initiatives related to revenue cycle performance and patient accessibility
- Provide subject matter knowledge to Fairview and external clients - Serve as a subject matter expert for financial counseling - Present and communicate with external clients- providing expertise and insight on copay assistance management - Standardize workflows and share best practices with clients
Required Qualifications
- A.A./A.S. Associates degree in healthcare administration, business, or related field or equivalent experience
- 3 years Experience in patient financial services, insurance verification, reimbursement, or healthcare revenue cycle
- 2 years Experience in home infusion, specialty pharmacy, medical billing, or insurance verification
Preferred Qualifications
- 1 year Prior experience in a lead, senior, or mentorship role preferred
- 1 year Ability to analyze complex financial scenarios and determine appropriate solutions
- 1 year Advanced knowledge of insurance coverage, reimbursement methodologies, and payer requirements
Benefit Overview
Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link foradditional information: https://www.fairview.org/careers/benefits/noncontract
Compensation Disclaimer
An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.
EEO Statement
EEO/Vet/Disabled: All qualified applicants will receive consideration without regard to any lawfully protected status