Financial Counselor

1 month ago

West Columbia, United States Lexington Medical Center Full time

Lexington ENT
Full Time
Day Shift
40 hours - Mon-Thurs, 7am-5pm

Consistently named best hospital, Lexington Medical Center anchors an expansive health care network that includes nearly 600 physicians and advanced practice providers at nearly 80 locations across the Midlands of South Carolina, making it the region's third largest employer. From general medicine and orthopaedics to oncology, cardiology and neurosurgery, these dedicated professionals combine the highest quality care with advanced medicine and state-of-the-art technology to help patients achieve the best possible outcomes. Its postgraduate medical education programs include family medicine and transitional year residencies.

Job Summary

Responsible for counseling patients regarding their insurance benefits; with accountability for collecting and/or establishing financial payment arrangements to adhere to LMC policy regarding the financial responsibility according to insurance carrier and/or self-pay obligations in order to have a positive financial impact on the practice. Interprets and applies compliance guidelines to maintain billing integrity.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 3 Years of insurance experience in a medical office practice
Substitutable Education & Experience (Optional): None.
Required Certifications/Licensure: None.
Required Training: Procedural knowledge of commercial, Medicaid, Medicare, Workers' Compensation, all contractual third party payers, other private carriers, billing, reimbursement, and regulatory compliance; Extensive knowledge of medical terminology, HCFA 1500, ICD10, and CPT coding.

Essential Functions

  • Works independently but closely with manager and operations director or division administrator.
  • Assist patient with benefit coordination to assure the appropriate financial obligation and responsibility is met in a timely manner.
  • Identify potential billing issues and act to resolve those problems quickly, and work collaboratively with physicians and managers regarding effectiveness in reimbursement rates, billing and collection.
  • Expectation is to stay current on all Governmental Reimbursement programs in order to provide assistance and guidance to leadership on reimbursement-related matters within the LMC contractual agreements.
  • Accurately prepare financial payment statements outlining benefits and collect appropriate funds and/or establish payment arrangements prior to date of surgery to maintain A/R days within set goals, as required.
  • Obtain and verify appropriate documentation from payor to establish coordination for clean claims.
  • Communicates with the CBO to assist as appropriate in the writing of appeals for denied claims and follow up on claims processing.
  • Assist CBO staff with accounts and reviews invoices for accuracy and completeness as deemed appropriate.
  • As requested, calculate estimates for visits, procedures, and/or surgeries, electronically managing records of estimates provided.
  • Verifies accuracy and correct use of ICD10 and CPT coding.
  • Compliance with carrier's policies.
Duties & Responsibilities
  • Post patient payments and assist with posting insurance payments, as deemed appropriate.
  • Research and follow-up on denials, claim corrections and rejections, as requested.
  • Provides accurate interpretation of EOBs, bulletins, advisories, fee schedules, payor guidelines, regulations and all other pertinent information.
  • Provides education to all office staff regarding financial counseling.
  • Assists patient, office staff, and insurance companies regarding claims, payments, adjustments, referrals and pre-certifications.
  • Maintains all informational material received from insurance companies, documenting all information within account notes.
  • Responsible for maintaining billing integrity: Fraudulent or abusive billing practices, (i.e., duplicate billing, overstating charges, etc.). Any exceptions should be brought to the immediate attention of the manager.
  • Demonstrates knowledge of commercial, Medicaid, Medicare, Workers' Compensation, all contractual third party payors and other private carriers.
  • Prepares and runs reports on a daily, weekly, monthly basis or as deemed appropriate.
  • Helps maintain the work area in a neat and orderly fashion. Responsible for keeping supplies needed to perform the job duties.
  • Demonstrates appropriate communication of information to all ages and responds to all customers/ patients requests and needs, i.e., hard of hearing, etc.
  • Respond to customer inquiries, complaints and correspondence in a prompt and professional manner to conform to LMC's Service Excellence guidelines and LMC's corporate compliance.
  • Performs all other duties as assigned.
We are committed to offering quality, cost-effective benefits choices for our employees and their families:
  • Day ONE medical, dental and life insurance benefits
  • Health care and dependent care flexible spending accounts (FSAs)
  • Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
  • Employer paid life insurance - equal to 1x salary
  • Employee may elect supplemental life insurance with low cost premiums up to 3x salary
  • Adoption assistance
  • LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
  • Tuition reimbursement
  • Student loan forgiveness

Equal Opportunity Employer
It is the policy of LMC to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. LMC strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. LMC endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee's desires and abilities and the hospital's needs.

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