Evergreen Health

The Financial Counseling Specialist is responsible for providing patient insurance assistance for patients of Evergreen Health. They will ensure these patients have healthcare coverage or appropriate payment arrangement in place in order for them to receive all available services at Evergreen. The Financial Counseling Specialist will have knowledge of health insurance and all aspects of patient registration through billing, and will communicate insurance issues to center staff and patients effectively, ensuring patient services will be reimbursed. The financial counseling specialist is a vital part of the Evergreen revenue cycle, as well as the positive patient experience at Evergreen.

As part of the essential functions, the Financial Counseling Specialist :

• Verifies all patient insurance 72 hours prior to scheduled appointments. Verifies insurance information, that insurance cards are entered into the patient’s chart correctly, reviews patient balances, and all financial notes in patient chart. Determines if patient is financially cleared for appointment or requires a visit to financial counseling center prior to visit, and places appropriate directive in EMR note for front desk staff.
• Calls any patient not cleared for any reason to meet with them prior to appointment. Meets with patient to assist with insurance, review balance, apply for programs, etc. Communicates when centers patient is cleared, follow up on applications, continue to communicate with patient as needed.
• Ensures that PLWHA who meet eligibility criteria will be enrolled in the program and receive assistance in applying for ADAP/ADAP Plus, Medicaid, ADAP Plus Insurance Continuation program (APIC), NYS of Health Marketplace coverage, or other available coverage options.
• Assists clients with transitioning from ADAP and ADAP Plus to comprehensive Marketplace insurance coverage, APIC, and other supplemental coverage.
• Assists patients with insurance enrollment through the NY State of Health Marketplace, along with tracking and assisting with any recertification needs.
• Provides friendly, knowledgeable, culturally competent service to all patients.
• Advises self-pay patients, collect payments, and develops patient payment plans if needed. Rec
• Screens patients for Sliding Fee Scale eligibility based on income and household size. Completes Sliding Fee applications with eligible patients.
• Contacts insurance company to verify patient coverage levels to ensure all procedures are covered.
• Works with patients to educate them on their benefits information if they need assistance.
• Identifies if a patient’s insurance requires a PCP change completed for patients receiving Primary Care Services. Documents this need in Medent and works with the Medical Case Management team to ensure the appropriate PCP is listed with insurance.
• Develops tools and processes to ensure insurance is obtained for every patient, and acts as a liaison between clinic and billing staff to ensure smooth billing process.
• Collaborates with the billing staff regularly to ensure no claims are being rejected due to incorrect insurance information.
• Assists billing staff on other billing processes, including credentialing, posting payments, denial research, etc.

Qualified Candidate will have a high school diploma (Associate's degree preferred). Minimum of six (6) months previous experience working with patients in a medical center/practice setting. Ideal candidate will have certification as a NYS Health Assistor and/or Certified Application Counselor. Must be able to communicate clearly and professionally in writing and verbally. Must have familiarity with MS Office Software (Outlook, Word, Excel). Candidate will have excellent time management skills, problem solving and organizational skills. Candidate will have knowledge of different types of insurance coverage and policies. Sensitivity toward cultural diversity, people living with HIV/AIDS and lifestyle and addiction issues essential .

Job Type: Full-time , Working a late shift of 11am to 7pm on Tuesdays is required as part of rotational schedule.

Required education: High school diploma (Associate's Preferred)

Required experience: Six (6) months previous experience working with patients in a medical center/practice setting

Preferred Certifications: NYS Health Assistor and/or Certified Application Counselor

What Evergreen Health Offers You: