The Patient Financial Ombudsman supports the Director of Revenue Cycle Optimization by serving as a neutral, confidential resource for patients and families to address unresolved medical billing concerns that cannot be resolved through standard customer service workflows. This role advocates for transparent revenue cycle practices, facilitates dispute resolution, and supports continuous improvement in the patient’s financial experience. Success in this role requires exceptional knowledge of revenue cycle operations and analytical skills, along with the ability to influence change and support a culture of accountability across the revenue cycle.

Essential Job Statements 

• Independently identify the root cause of medical billing concerns by conducting a thorough review of revenue cycle processes, including clinical documentation, coding practices, provider set-up, system configuration, benefit structure, and payer responses.  

• Lead collaborative, multi-stakeholder discussions to validate findings and implement solutions by engaging representatives from patients’ health insurance plans, Ensemble Health Partners, VCUH Human Resource Staff Benefits, VCUH Revenue Cycle Operations, VCUH Information Technology, MCV Physicians, and other internal stakeholder teams. 

• Communicate with patients about findings and solutions, including educating about billing processes and patient financial rights and providing guidance on financial liability, payment plan options, and available financial assistance programs. 

• Monitor recurring billing errors and systemic trends, and provide actionable insights to improve workflows, reduce denials, and enhance overall revenue cycle performance. 

• Contribute to the design, testing, and launch of revised workflows, policies, and training initiatives aimed at ensuring accurate and compliant billing practices and enhancing the patient’s financial experience. 

• Develop and present regular reports detailing case volumes, resolution metrics, and improvement opportunities. 

• Ensure strict compliance with internal policies and external regulations, including HIPAA, CMS, and payer-specific requirements. 

Patient Population 

Not applicable to this position.

Employment Qualifications 

Required Education: 

Bachelor’s degree or equivalent experience in field related to patient revenue cycle management 

Preferred Education: 

Licensure/Certification Required: 

Licensure/Certification Preferred: 

Minimum Qualifications 

Years and Type of Required Experience 

Minimum five (5) years of direct experience in revenue cycle operations  

Minimum three (3) years of experience interpreting insurance benefits 

Minimum three  (3) years of experience with Epic or similar revenue cycle management system 

Other Knowledge, Skills and Abilities Required: 

In-depth knowledge of medical billing, coding practices, and insurance benefit structures is essential. 

Strong analytical, problem-solving, mediation, and customer service skills are crucial for success in this role. 

Ability to handle multiple priorities and adapt to frequent change. 

Ability to work independently and maintain neutrality. 

Skilled in Microsoft Excel, Word, and PowerPoint.  

Cultural Responsiveness

Other Knowledge, Skills and Abilities Preferred: 

Working Conditions 

Periods of high stress and fluctuating workloads may occur. 

General office environment. 

May have periods of constant interruptions. 

Physical Requirements 

Physical Demands:

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards    

Physical Requirements: Manual dexterity (eye/hand coordination), Repetitive arm/hand movements

Hazards:

Mental/Sensory – Emotional     

Mental / Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking 

Emotional: Fast-paced environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change 

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.