Financial Counselor - PT Access Financial Counseling - 003

We are searching for a Financial Counselor - working in the Family Fertility Center - someone who works well in a fast-paced setting. In this position, you will be responsible for completing insurance verification on all new admissions assigned by the Manager or Director, and for ensuring that all assigned inpatient/outpatient visits contain complete and accurate demographic and financial information. In addition, the Financial Counselor also works with international payers, financial institutions, and foreign hospitals to secure financial coverage for international patients. Finally, the Financial Counselor may be utilized as overflow coverage or during downtime situations for the Patient Access Representative (also known as Admission Counselor or Patient Administrative Liaison (PAL) and is accountable for responsibilities outlined in the respective job descriptions.

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Job Duties & Responsibilities

Performs insurance verification, determines primary, secondary, and tertiary payers and follows up on inpatient and outpatient accounts throughout the entire course of treatment.

Contacts insurance company (s) and notifies them of the patient’s admission within 24 hours of admission in accordance with Payer’s contracted guidelines. Reviews copy of insurance card(s); obtains initial authorization and benefits/eligibility; confirms coordination of benefits and assigns correct plan code by evaluating the payer sources that drive reimbursement (i.e. capitated allowance versus collection of per diem or discount of charges) and strategic planning from download to the Hospital’s cost accounting system. Confirms eligibility with the insured’s employer. Identifies the birth date of the parent(s) or guarantor(s). Obtains clinical and financial authorization as required by contract for services. No more than three accounts greater than $1,000, or multiple write-offs that total more than $5,000 are written off due to unauthorized services as measured by denial reports.

All communications are clearly and objectively documented, and scanned into the documents table when applicable, in the patient notes section in the Epic system in real time as found during account reviews and audits.

Adheres to the Hospital’s contractual guidelines with insurance companies when obtaining initial or continuing authorization for services. Effectively communicates with the Care Manager or Social Worker to facilitate timely compliance in providing necessary information for authorization. Refers any problem or issue to the Manager or Director to discuss with Care Management.

Utilizes the Work Queue daily to track the status of accounts placed on hold by other departments (i.e.: medical records, pre-admit teams, and patient accounting). Follows up with the guarantor within 1 business day of admission if there is a question or issue with insurance coverage and makes every effort to secure the account prior to patient’s discharge as documented in the account notes.

Verifies pharmacy benefits for all Hematology/Oncology, Cardiology, Neonatology, and other assigned service patients in order to determine if assistance will be needed for discharge medications as documented in account notes and phone records.

Reviews Work Queue for transplant patient and contacts the transplant coordinator to determine if the visit is transplant related or disease management. Updates flags, patient notes in the Epic system, and plan codes for appropriate billing.

Secures scheduled clinic visits prior to the date of service. Notifies and coordinates options for care with the physician/clinic nurse when a visit is not financially secured prior to the date of service. Determines with the provider if the visit can be rescheduled, or if patient should be redirected to another provider, such as the Primary Care Physician for continuing care.

Provides International Patient Services with an estimate for both physician and facility charges prior to visit based on information provided by the International Patient Services. Ensures Letter of Guarantee/Authorization is obtained, scanned and indexed to the documents table in Epic.

Meets with the family regarding their financial status to determine potential assistance for third party coverage in a timely and sensitive manner.

Makes every effort to minimize the loss of reimbursement for both inpatient and outpatient visits by securing coverage prior to discharge (unscheduled admissions) or during the patient’s visit.

Maximizes the efficiency and accuracy of the collection process on scheduled patients.

Participates in the department’s process improvement program.

Provides required documentation in the patient’s chart, including signed forms such as general consent, information release, advanced care directives, and other documents required by JCAHO and other regulatory bodies and obtains required signatures.

Skills & Requirements

H.S. Diploma or GED required

bachelor's degree with an emphasis in Business preferred

2 years of related experience required