Patient Financial Assistance Counselor

Job Summary:

The Patient Financial Counselor is responsible for providing patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. Patient Financial Counselors are the patient’s point of contact for financial assistance questions. The Patient Financial Counselor collects patient payments, sets up payment plans as appropriate and according to guidelines, creates estimates, advises patients over the phone and in person regarding their insurance benefits and coverage. This role gathers essential information used to determine eligibility for government programs, financial assistance programs (charity care), and other options for managing high financial liabilities.

Independent judgment and decision making is required to address the full range of tasks and responsibilities. The position requires the ability to plan, schedule and organize numerous tasks that directly impact reimbursement. This position represents Chapters Health System and the Revenue Cycle team.

Core Responsibilities:

• Identifies opportunities to increase third party insurance billings (e.g. through helping patients enroll in assistance programs)
• Serves as the patient’s point of contact for all financial assistance related questions.
• Communicates with patients to identify and understand financial, social, and other relevant patient information.
• Gathers all relevant information required to process financial assistance requests for Medicaid, Charity funding, any other applicable assistance programs
• Documents communication and follow up in the EMR
• Determines the patient’s financial ability to pay and explains insurance coverage and benefits to the patient.
  • Initiates the financial screening process as appropriate to evaluate eligibility for assistance programs.
  • Identifies eligible financial programming options and assists patient with completing necessary documentation for specific federal, state, or Chapters financial assistance programs.
• May coordinate/assist in obtaining exceptions to the out of network determinations from insurance companies, escalate if necessary.
• Explains Chapters payment policy to patients if a program is not available. Calculates and explains any patient liability before or at the time of service.
• Counsels patients on out of pocket liabilities.
• Collects deductibles, pre-payments, and outstanding balances following established collection procedures; or alternatively, creates a payment plan with the patient and documents the agreement appropriately.
• Tactfully communicates financial coverage status and applicable financial decisions with appropriate parties: patient, family, other Chapters team members, etc.
• Thoroughly notates accounts status in system; Maintains complete records of all patients applying for indigent or financial assistance to include the application, proof of income, the acceptance/denial letter, and any other applicable documentation

Qualifications

• At least 3 years of Patient Financial Counseling or Social Worker experience preferably at a hospital, hospice, or other acute care setting
• Associates Degree or comparable experience
• Experience establishing health insurance benefits, conditions, and requirements by making phone inquiries, and by using eligibility systems and the internet.
• Ability to communicate in a tactful and emotionally intelligent manner with patients and families
• Knowledge of medical insurance and government payers and reimbursement
• Excellent customer service skills and experience
• Proficiency in Microsoft Office applications; especially Excel.
• Familiarity with healthcare regulations