Summary:
Under the general supervision of the Manager Patient Registration the Financial Counselor functions as a liaison between the hospital and patients to facilitate the solution of patient financial issues concerning outpatient and inpatient pre-admission pre-registration pre-scheduled scheduled inpatient/observation direct and emergent admissions.
Responsibilities:
Pre-admits/registers scheduled outpatients and inpatients in hospital system.
Contacts insured patients to verify demographics obtained at the time of scheduling to complete any missing information.
Verifies patient insurance coverage (both primary and secondary) online or by telephone.
Obtains and verifies coverage authorizations for scheduled and unscheduled patients to include all sources such as Workers Compensation Medicare Secondary Payer (MSP) Medicare liability liens etc.
Ensures referrals are obtained and confirms accuracy of the Primary Care Physician (PCP).
Establishes level of insurance benefits and expected payment for selected services. Determines the patients portion of payment when applicable and arranges for payment prior to the provision of services.
Upon arrival or admission or in the patients room completes any missing documentation required from patients and/or family members.
Checks outstanding balances incurred for previous services prior to contacting patient and follows collection policy concerning prepayment prior to the provision of additional services.
Monitors in-house accounts for open patient balances resulting from co-payments and deductibles. Tracks Medicare Days and Lifetime Reserve Days when applicable.
Authorizes occupancy and collects payments for Private Room Differentials. Reviews bed transfer list daily to ensure the authorization and collection of all appropriate private room transfers.
When appropriate medical necessity verifications for services to be provided will be performed by the servicing department and will also require that Advance Beneficiary Notices (ABNs) be addressed for payment at the time of admission/arrival.
Refers insured patients who cannot meet their financial obligations including previously incurred hospital balances current admission/outpatient expected non-covered charges and ABNs to Patient Advocates according to department policy.
Updates status of financial clearance activities in hospital system.
Prepares/assembles all necessary paperwork prior to the patients arrival.
Reviews/corrects third party payer eligibility reports.
Completes real time status transfers.
Performs other duties as required to support the operations of the department.
May be required as needed to provide coverage at numerous locations (hospital-based): Admitting ED and Outpatient areas as well as off-site registration areas and Business Office.
Attends and participates in staff meetings.
Other information:
BASIC KNOWLEDGE:
A level of knowledge generally obtained through completion of High School.
Knowledge of medical terminology third party insurance information and standard computer applications required. Good verbal and written communication skills.
Computer skills that permit and facilitate the performance of work responsibilities.
Demonstrated knowledge and skills necessary to provide care patients with consideration of aging processes human development stages and cultural patterns in each step of the care process.
EXPERIENCE:
Two years in a hospital environment with previous experience in third party payer verification and authorization process requirements and an understanding of payer contracts. Training in HIPAA rules and regulations.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Office environment with some exposure to the normal patient care environment as some patient interviews are conducted with patient and family members on the nursing units. Sitting for long periods of time at a workstation requiring continuous use of a computer and telephone.
INDEPENDENT ACTION:
Performs independently within the departments policies and practices. Refers specific complex problems to the supervisor when clarification of departmental policies and procedures are required.
SUPERVISORY RESPONSIBILITY:
None.
Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.
Location: The Miriam Hospital USA: RI: Providence
Work Type: Part Time
Shift: Shift 1
Union: Non-Union