Financial Services Representative

2 days ago

Grants, New Mexico, United States Cibola General Hospital Full time
Job Summary

Cibola General Hospital is seeking a highly skilled and compassionate Financial Counselor to join our Patient Financial Services team. As a Financial Counselor, you will play a critical role in providing patients with a positive financial experience by helping them navigate and understand their insurance benefits and potential financial liability.

Under the direction of the Patient Financial Services Director, you will be responsible for collecting payments, setting up payment arrangements, creating estimates, and advising patients on their insurance benefits and coverage. You will also assist patients with eligibility for government programs, Cibola General Hospital's financial assistance program, and other options for managing high medical liabilities.

Key Responsibilities
  1. Serve as the point of contact for all financial assistance related questions.
  2. Communicate with patients to identify and understand their financial, social, and medical histories and other relevant patient information.
  3. Gather all relevant information required to process financial assistance requests, including working with providers on treatment plans, best practices, and related necessary medical opinions.
  4. Document all communication and follow-up in the EMR and send written confirmation to patients regarding payment arrangements, etc., as applicable.
  5. Assess the current financial situation of patients through the verification of patient insurance benefits, serving as the technical expert in confirming patients' benefit coverage and hospital reimbursement.
  6. Determine the patient's financial ability to pay and explain insurance coverage and benefits to the patient.
  7. Initiate the financial screening process as appropriate to evaluate eligibility for assistance programs.
  8. Assist patients in completing financial statements and gathering supporting financial documentation.
  9. Complete the referral pattern for patients with financial risk.
  10. Determine eligibility for care at CGH by assessing patient eligibility for Medical Assistance, Emergency Medical Assistance, Community Programs, and Government Programs.
  11. Assess and offer payment alternatives, which may include prepayment for elective care, and applying for CGH's financial assistance program.
  12. Identify eligible financial programming options and assist in completing all necessary documentation for specific federal, state, or CGH financial assistance programs.
  13. With provider involvement, determine the urgency of scheduled care for patients with large financial liabilities, resulting in either a decision to proceed, hold, reschedule, etc.
  14. Explain CGH's payment policy to patients if a program is not available to assist with payment.
  15. Calculate and explain any patient liability before or at the time of service.
  16. Counsel patients on out-of-pocket liabilities and collect deductibles, pre-payments, and outstanding balances following established collection procedures, or alternatively, create a payment plan with the patient and document the agreement appropriately.
  17. If unable to establish acceptable payment arrangements for elective procedures, inform the provider and patient that services will be rescheduled or cancelled.
  18. Communicate financial coverage status and applicable financial decisions with all appropriate parties: patient, family, referring clinicians, and CGH clinicians.
  19. Assist with the maintenance of self-pay accounts, initiate collection procedures when appropriate, and send out letters to patients regarding the status of the accounts; place accounts in the financial class needed before the account goes to collections if patients do not respond to calls and letters.
  20. Pursue and participate in education opportunities to remain current with changes in the Healthcare industry.
  21. Promote effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.
  22. Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
  23. Attend on-site/off-site community engagement activities and on-site/off-site clinic events as needed.
  24. Perform other duties as assigned.
Education and Experience

Candidates must have a High School Diploma/GED and an Associate degree is preferred. Two years' experience in healthcare Revenue Cycle is preferred, along with experience in providing high-level customer service. Excellent organization and time management skills, along with excellent oral and written communication skills, are required. Strong team player with the ability to learn quickly, build and maintain long-term relationships, and work with minimal supervision. Proficient computing skills are necessary, along with a high level of accuracy and attention to detail, flexibility, and ability to attend to competing priorities in an effective and timely way.

Knowledge, Skills, and Abilities
  1. Knowledge of medical billing/collection practices.
  2. Knowledge of computer programs.
  3. Knowledge of business office procedures.
  4. Knowledge of basic medical coding and third-party operating procedures and practices.
  5. Ability to operate a computer, basic office equipment, and a multi-line telephone system.
  6. Skill in answering a telephone in a pleasant and helpful manner.
  7. Ability to read, understand, and follow both oral and written instructions.
  8. Ability to establish and maintain effective working relationships with patients, co-workers, and the public.
  9. Must be well-organized and detail-oriented.
Additional Qualifications
  1. Bilingual (Spanish/English) is a plus.
Relationship Reporting
  1. Reports to the PFS Supervisor.
Physical Requirements
  1. Ability to sit, stand, walk, or view a computer screen for extended periods of time.
  2. Ability to perform repetitive hand and wrist motions for extended periods of time.

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