Company Description
About Patient Funding Alternatives (PFA)
At Patient Funding Alternatives (PFA), we remove the barriers that keep Medicaid-eligible and medically underserved people from getting the care they deserve. We partner with hospitals and health systems across the country to help patients secure coverage through employer-sponsored insurance, which simplifies the process for the patient, protects them financially, and improves outcomes for the hospital.
We are the only organization in the U.S. offering a full Premium Assistance Enrollment service supported by dedicated Patient Advocates working on-site inside partner hospitals.
PFA is growing quickly nationwide, and that growth rests on people who care about the patients in front of them. We believe our employees are our most valuable resource, and we work hard to protect a real work/life balance inside a culture built on empathy, teamwork, and respect.
Job Description
About the role
The Patient Advocate Specialist identifies, educates, and enrolls eligible hospital patients into the Health Insurance Premium Payment (HIPP) program. HIPP lets medically complex Medicaid beneficiaries access employer-sponsored coverage alongside their Medicaid benefits, which opens up broader networks and more comprehensive care.
This is a full-time hybrid role, 2-3 days per week on-site based at MercyOne Children's Hospital. You are PFA's face inside those buildings.
Read this part carefully, because it is the part people misjudge. The day-to-day of this job looks a lot like a sales role. You work a referral list. You approach patients and families who did not ask to speak with you, often on a difficult day. You explain something unfamiliar in 3 minutes, answer the same 5 objections you heard yesterday, and follow up 4 or 5 times to get one form back. You are measured every week on activity and results. Nothing is being sold and there is no commission pitch, but the skills that make someone good at sales are the same skills that make someone good at this: persistence, comfort with rejection, reading a room, and running your own day without someone assigning your next task.
The people who do this best pair those skills with a real belief in what the program does for patients. One without the other does not hold up.
What you'll do
Patient engagement and advocacy
-
Identify and approach eligible patients and families from hospital referrals and daily census review.
-
Explain HIPP clearly and compassionately, adapting how you communicate to each family's situation.
-
Work through hesitation, confusion, and mistrust without pressuring anyone.
-
Gather the authorizations and documentation needed to move an application forward.
-
Build trust with patients while holding professional boundaries.
Enrollment and case management
-
Collect complete, accurate application data: employer details, plan information, premium costs, dependent information.
-
Solve problems before they stall a case, including unresponsive employers, missing paperwork, and eligibility questions.
-
Hand off cleanly to PFA's State Operations and Benefit & Advocacy teams so applications get submitted, approved, and supported after enrollment.
-
Own your caseload from first contact to enrollment.
Program maintenance and benefit coordination
-
Explain how employer coverage and Medicaid work together.
-
Verify and update ongoing eligibility so families do not lose coverage.
-
Help patients resolve insurance issues as they come up.
Documentation and systems
-
Manage referrals and patient records in PFA's CRM.
-
Upload, scan, and transmit documentation securely.
-
Document every patient interaction in line with HIPAA and internal compliance standards.
-
Work comfortably on an iPad and iPhone throughout the day.
Hospital relationships
-
Represent PFA on-site as the primary contact for hospital staff.
-
Build working relationships with case managers, social workers, financial counselors, state agency contacts, and community partners.
-
Protect PFA's reputation inside the health system through how you handle every interaction.
How success is measured
This role sits in a metrics-driven environment, and we are direct about that from the first interview. You will have weekly and monthly targets, review them with your manager regularly, and see your own numbers.
The measures include:
-
Patients contacted and screened
-
Applications started and completed
-
Referral-to-enrollment conversion rate
-
Time from first contact to submitted application
-
Documentation accuracy and compliance
-
Ongoing eligibility renewals maintained
People who like knowing where they stand tend to enjoy this. People who prefer work that is not counted usually do not stay.
Qualifications
Required qualifications
-
High school diploma or GED.
-
Full Bilingual proficiency in Spanish.
-
2 or more years in a patient-facing or customer-facing role where you were measured on activity or outcomes. Healthcare settings preferred, but retention, enrollment, collections, member services, and inside sales backgrounds all translate.
-
Comfort working independently on-site with limited daily supervision.
-
Working proficiency with a CRM or case management system, plus iPad and iPhone.
-
Ability to pass hospital credentialing, including required vaccinations and drug/alcohol screening.
Preferred qualifications
-
3 to 5 years in patient-facing roles in a hospital or health system.
-
Working knowledge of Medicaid and Medicare eligibility, employer-sponsored coverage, and coordination of benefits.
-
Direct HIPP or premium assistance experience, or experience with an eligibility and enrollment vendor.
-
Background in patient access, patient financial services, financial counseling, health plan member services, or benefits enrollment.
-
Full bilingual proficiency in Spanish.
-
Associate's or Bachelor's degree in Social Work, Healthcare Administration, Public Health, or a related field.
-
Training in motivational interviewing, trauma-informed care, or medical billing and coding.
-
Ability to read and interpret an EOB, a benefits summary, or a medical bill.
What makes someone good at this
-
Mission-driven. You are genuinely motivated by getting a family covered, and it shows in how you talk about past work.
-
Persistent. You can hear no on Monday and go back on Thursday without taking it personally.
-
Empathetic and professional at the same time. You can sit with someone on the worst week of their life and still get the form signed.
-
Urgent. Coverage windows close. You move quickly without rushing the patient.
-
Detail-oriented. Applications get denied over small errors, and you catch them.
-
Culturally competent. You adapt to the person in front of you.
-
Adaptable. Medicaid policy, hospital processes, and internal procedures all change, sometimes with little notice.
This may not be the right role for you if
-
You prefer a predictable desk role without outreach or targets.
-
You would rather wait for patients to come to you.
-
Being measured weekly on activity and conversion sounds stressful rather than clear.
-
You are looking for a fully remote position.
Additional Information
Incentive bonus plan
Patient Advocate Specialists earn a base salary plus an incentive bonus tied to enrollment performance. We walk through the plan and the targets behind it during the interview process, so you know exactly how it works before you accept an offer.
Our benefits: supporting your total wellbeing
At PFA, we invest in your total well-being. You'll have access to a comprehensive benefits package that includes employer-subsidized medical coverage, supported by a supplemental cost-offset benefit that helps reduce your out-of-pocket expenses at the point of care. Additional benefits include dental and vision coverage, company-paid life and disability insurance effective day one, a 401(k) retirement program which includes up to a $2,000 annual match, flexible spending accounts, an Employee Assistance Program, and a wellness benefit, all designed to support you and your eligible dependents from the moment you join our team.
