Financial Counselor

Job Summary:

We are seeking a highly skilled Financial Counselor to join our team at North Oaks Medical Center. As a Financial Counselor, you will play a critical role in ensuring that patients receive the financial assistance they need to access quality healthcare services.

Key Responsibilities:

1. Screen patients for Medicaid programs, Supplemental Security Income, and financial assistance, and complete and process applications as necessary.
2. Maintain follow-up on Medicaid and financial assistance applications for approval, ensuring timely resolution of patient accounts.
3. Verify, obtain, and correct insurance information to ensure accurate billing and reimbursement.
4. Have working knowledge of insurance billing, reimbursement, and third-party payer specifications to ensure compliance with admission criteria, pre-certification, prior authorization, and second opinion requirements.
5. Complete Charity Care Assistance Applications for indigent care patients, gathering financial information, completing the application, and routing all information for approval.
6. Interact with Social Service, Case Management, Insurance Verification, and Nursing Units to resolve patient financial concerns.
7. Ability to work well under stressful conditions, including effectively assisting irate patients and/or family members.
8. Make financial agreements, including employee payroll deduction, and obtain monetary collections on patient accounts.
9. Follow up on paperwork received from Resolution Analysts, Admit Scheduling, or Insurance Verification Personnel for private pay patients or patients with large deductibles or co-payments.
10. Research and write up account adjustments on the proper adjustment form and route for the appropriate signatures of authorization.
11. Prepare and present Medicare notice of observation status to patients and document findings.
12. Research financial records and returned mail on a daily basis.
13. Refer accounts to Nurse Auditors for patient request audits of account charges when necessary.
14. Promptly process mail to obtain account information as received.
15. Assist with the training of new employees.
16. Provide patients with COIB upon request.
17. Contact Medicaid, Medicare, Commercial Insurances, and/or Third Party Payers for status of claims on a daily basis.
18. Contact Collection Agency on Bad Debt accounts when necessary, including researching and resolving collection agency correspondence.
19. Help resolve problem admissions according to hospital financial policy when necessary.
20. Work reports as assigned by Supervisor/Coordinator/Director within time frames set for each report.
21. Transfer balances to patient balance daily after insurance pays, denies, or when deemed appropriate.
22. Call or write patients, insurance companies, and employers for additional information needed to process claims when necessary.
23. Request medical records when needed to process claims or resolve patient concerns on an account.
24. Serve as the back-up to the NOMC Cashier and Collection Specialist as needed.
25. Handle special requests and administrative overrides on accounts from Administration.
26. Report patient concern in full detail to Patient Financial Services Management to enter into Quantros for follow-up.
27. Daily document in system notes all factual information and activities pertaining to the account.
28. Consistently have open communication with all hospital departments.
29. Maintain confidentiality and adhere to HIPAA Compliance.
30. Attend in-services and other meetings as required.
31. Efforts must be made to achieve and exceed departmental goals on an ongoing basis.
32. Must maintain performance and productivity levels set within the performance indicators.

Requirements:

• High school graduate or equivalent 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.

Work Environment:

This is a full-time position, Monday through Friday, 8:00 a.m. to 4:30 p.m., with some occasional weekends.

Exempt: No