FINANCIAL COUNSELOR - FINANCIAL ASSISTANCE CENTER
Status: Full Time
Shift: Monday - Friday 8-4:30 varies
Performs account follow-up and resolution of patient receivables.
High school graduate or equivalent is required
General math skills required
Minimum of two years of customer service, problem resolution and telecommunication experience.
Hospital billing experience desirable.
Knowledge of Medicaid and Charity Care. Working knowledge of billing, benefit verification, pre-certification and reimbursement policies of third party payers required.
Medical terminology helpful.
Data entry and computer skills.
Excellent written and oral communication skills.
1. On a daily basis, monitor and interact with the patient/family member to screen and provide various types of financial assistance to patients while maintaining positive public relations.
2. Screen patients for all Medicaid Programs, Supplemental Security Income, and Financial Assistance. Complete and process applications as appropriate.
3. Maintain follow up on Medicaid and Financial Assistance applications for approval. Medicaid follow up in 15 days after submission and Financial Assistance needs to be followed through until a final determination is received.
4. Verify, obtain and if necessary correct Insurance information and add appropriate carrier/plan information, ensuring that all steps have been completed so that proper billing, follow up and reimbursement can be obtained.Insurance information may be obtained from the patient through a phone call, walk-in, mail, etc.
5. Have working knowledge of insurance billing, insurance reimbursement and third party payer specifications in regard to admission criteria, pre-certification, prior authorization or second opinion requirements.
6. When necessary, complete a Charity Care Assistance Application for “indigent care” patients. This process includes gathering financial information, completing the application, noting all accounts, routing all information for approval.
7. When necessary, interact with Social Service, Case Management, Insurance Verification and Nursing Units involving patient financial concerns.
8. Ability to work well under stressful conditions, including the ability to affectively assist an irate patient and/or family member.
9. Make financial agreements, per the Payment Plan Policy, including but not limited to employee payroll deduction.
10. Obtain monetary collections on a patient’s account(s) either by a deposit on an account, first payment of a payment plan, and/or payment in full.
11. Immediately follow up on paperwork received Resolution Analysts, Admit Scheduling, or Insurance Verification Personnel for private pay patients or patients with a large deductible or co-payment. This follow up includes but is not limited to verify the insurance coverage, obtaining additional insurance information, requesting a deposit from the patient/family member.
12. Research and write up account adjustments on the proper adjustment form and route for the appropriate signatures of authorization, as outlined in the adjustment policy when necessary.
13. Prepare and present Medicare notice of observation status to patients and document findings.
14. Research financial records and returned mail on a daily basis.
15. While reviewing a patient account history if an account with a credit balance is identified refer the account to the appropriate employee to research and process third party and patient refunds and/or to correct the misapplication of funds.
16. Refer accounts to Nurse Auditors, according to the policy, for a patient request audit of the account charges when necessary.
17. On a daily basis, promptly process mail to obtain account information as received.
18. Assist with the training of new employees.
19. Provide patients with COIB upon request whether request is from daily mail, phone call or walk-in.
20. Contact Medicaid, Medicare, Commercial Insurances, and/or Third Party Payers for status of claims on a daily basis.
21. Contact Collection Agency on Bad Debt accounts when necessary; including researching and resolving collection agency correspondence.
22. Help resolve problem admissions according to hospital financial policy when necessary.
23. Work reports as assigned by Supervisor/ Coordinator/ Director within time frames set for each report.
24. Transfer balances to patient balance daily after insurance pays, denies or when deemed appropriate.
25. Call or write patients, insurance companies and employers for additional information needed to process claims when necessary.
26. Request medical records when needed to process claims or resolve a patient concern on an account.
27. Serve as the back up to the NOMC Cashier and Collection Specialist as needed.
28. Handle special requests and administrative overrides on accounts from Administration.
29. Report patient concern in full detail to Patient Financial Services Management to enter into Quantros for follow up.
30. Daily document in system notes all factual information and activities pertaining to the account.
31. Consistently have open communication with all hospital departments.
32. Maintain confidentiality and adhere to HIPPA Compliance.
33. Attend in-services and other meetings as required.
34. Efforts must be made to achieve and exceed departmental goals on an ongoing basis.
35. Must maintain performance and productivity levels set within the performance indicators.
- Follow North Oaks Health System policy and procedures, compliance program and all Federal and State regulatory guidelines.
- Complete all educations assigned via Net Learning.
38.Perform other duties as assigned.