Responsibilities

The Financial Counselor is responsible for verifying benefits and eligibility for potential and actual patient admissions, for completing the actual admission/registration process required for the patient’s admission to the hospital and for assisting in the preparation of the financial folder. The position is also responsible for providing patient financial counseling and collecting any out of pocket amounts from patients at the time of or during admission.

This position is responsible for coordinating with Intake and Utilization Review Departments and communicating appropriate information regarding benefit and coverage requirements in a timely manner to allow them to obtain timely and accurate authorization for the patient’s stay.

The Financial Counselor is responsible for identifying potential payment and risk issues, and communicating this information, to the Admissions Manager or the Business Office Director in a timely manner. The Financial Counselor will, in all cases, assist the hospital in ensuring that the highest level of integrity and compliance with known payer requirements is maintained at all times and reflected accurately within the areas of their responsibility.

The Financial Counselor acts as a technical resource regarding all aspects of Admissions and financial counseling. The Financial Counselor is responsible for providing admissions training to other Business Office personnel, Reception, and Intake staff as needed, as well as assisting in developing appropriate policies, procedures and forms for use in the admissions office.

Qualifications

• High school graduate with a minimum of two years experience in admissions and/or collections
• Working knowledge of managed care and business software programs
• A good understanding of insurance plans and the ability to interpret benefits and calculate copays, deductibles, and coinsurance is also very helpful

JOB DUTIES AND STANDARDS OF PERFORMANCE:

• Complete the admission/registration process with the patient and family.
  • Complete all admission forms accurately and obtain appropriate signatures as required.
  • Complete special Medicare, Tricare, Group Health and other required payer forms during the admission process if appropriate.
  • Review patient demographics and insurance information and make corrections as needed during the admission to maintain the integrity of our database.
  • Take the patient’s picture and print rounds sheets prior to taking them to the unit. Coordinate with Nursing Staff to ensure the safety and well-being of the patient at all times.
  • If insurance has been verified review benefits and collect the patient’s out of pocket estimate due during the admission process. If it is a self-pay account, collect a deposit towards the anticipated portion owed. For self-pay accounts notify the Admissions Manager and Business Office Director (BOD) to mitigate financial losses.
  • Sort and distribute the admission forms appropriately to ensure timely completion of the patient’s medical chart.
  • Review financial packets from after-hours admissions and ensure that all paperwork is accounted for and the admission is completed to our department standards.
• Verify insurance eligibility and benefits prior to the arrival of the patient (if possible) or within 24 business hours of admission.
  • Verify Medicare, Medicaid, and commercial insurance benefits in an accurate and timely manner and ensure that the benefit sheet is accurate and legible.
  • Send a copy of the Insurance Verification to the Authorization Clinician by the morning after the admission (at the latest) to ensure timely notification of admission and authorization of the stay.
  • Enter the verification of benefits note and message code in the patient accounting system (MS-4).
  • Communicate coverage limitations, lapse in benefit, pre-existing condition situations, and other potential risks of non-payment to the Business Office Director and Admissions Manager upon discovery.
  • Inform the Admissions Manager of any potential backlog in verifications so that other staff can be utilized to ensure timely and accurate verifications at all times.
• Conduct a financial counseling interview with patient and/or family within 24 hours or next business day of admission.
  • Complete Patient Responsibility Calculation Spreadsheet based on insurance benefits prior to meeting with the patient.
  • Explain coverage and benefits to patient and/or family and collect estimated patient portion.
  • If the patient indicates inability to pay, inform them of the Charity Care policy and if needed, assist them in completing a Charity application.
  • Financial Counselor is required within six (6) months of hire to complete their Washington State Navigator Credentialing in order to assist patients with completing MediCaid Applications while admitted.
  • Enter thorough documentation of all encounters with the patient and family in the patient accounting notes (MS-4) and enter an appropriate message code as well.
• Maintain in-house accounts in good order and respond to requests from other departments and Business Office staff in a timely and appropriate manner.
  • Follow up with patients on the Unit to get incomplete paperwork done within 24 hours of admission and continue to try to get involuntary patients to comply throughout the stay.
  • Keep accurate and timely notes in MS-4 of any interaction with the patient or family while the patient is in house.
  • Make needed corrections to patient accounts whenever previously entered information is found to be incorrect and share the updates with the BOD and Admissions Manager.
  • Coordinate with Discharge Planners to obtain benefits for a reduced level of care when appropriate.
  • If the patient has completed a Medicaid application, enter it into the DSHS system.
  • If the patient has not paid their portion of the bill by discharge, assist them in determining effective payment arrangements at discharge or within 7 days of discharge date.
  • Maintain the Front End Collection Log and update it when patient portions are collected.
  • Must maintain Up Front Collections Log and meet department goals as stated by Admissions Manager to be considered for monthly monetary incentive.

ADDITIONAL STANDARDS OF PERFORMANCE:

• Utilize the principles of service excellence in all work situations.
  • Treat everyone as a guest.
  • Demonstrate professionalism and excellence in the things I do.
  • Practice teamwork.
• Be dependable and reliable.
  • Report to work at scheduled start time and comply with the attendance policy.
  • Follow facility policy for use and reporting of planned leave.
  • Follow work assignments/instructions as indicated and utilize work time and resources in an efficient, economical manner.
  • Attend Handle with Care and Verbal De-escalation training as required and seek learning opportunities.
  • Participate as a positive, professional team member.
  • Comply with the facility dress code.
  • Flexibility and ability to cover Financial Counseling positions on other campuses as needed.
  • Complete HealthStream Modules as assigned in a timely manner.

JOB FACTORS:

• Knowledge of facility and corporate policies and procedures.
• Skill in organizing and prioritizing workloads to meet deadlines.
• Skill in telephone etiquette.
• Effective oral and written communication skills.
• Must have excellent interpersonal communication skills to effectively communicate ideas/problems/instructions (oral or written) with peers, and hospital leadership.
• Ability to communicate effectively with patients and families.
• Ability to adhere to safety policies and procedures.
• Ability to use good judgment and to maintain confidentiality of information in accordance with Health Insurance Portability and Accountability Act (HIPAA) .
• Ability to work as a team player.
• Ability to demonstrate tact, resourcefulness, patience and dedication.
• Ability to accept direction and adhere to policies and procedures.
• Ability to recognize the importance of adapting to the various patient age groups (adolescent and adult).
• Ability to analyze situations, evaluate data, recommend/implement courses of action that would improve the functioning of systems/processes he/she is involved in.
• Ability to interpret, adapt and apply guidelines and procedures.
• Ability to work in a fast-paced environment.
• Ability to meet corporate deadlines.
• Ability to react calmly and effectively in emergency situations.

PHYSICAL, MENTAL, AND SPECIAL DEMANDS

• Ability to work at least a 40-hour week.
• Ability to sit for long periods (8 to 10 hours).
• Ability to use both hands in fine manipulation of small tools (copier, computer, telephone, typewriter, calculator, safe, facsimile machine).
• Ability to push and pull up to 10 lbs. (file cabinet drawers, computer paper boxes).
• Ability to see well enough to read handwritten and typewritten material.
• Ability to lift and carry up to 25 lbs. to move/transfer file boxes, and data processing paper.
• Ability to stoop, kneel, and bend to retrieve files from bottom shelves and drawers, to move boxes of paper and forms to computer printer.
• Ability to reach, turn, and twist above and below the waist.
• Ability to stand and walk the facility grounds.
• Ability to spend 10% of working time outside in temperatures varying from below 0° F. to 110°F.
• Ability to spend 90% working time in environment of continuous low voices and office machine noise typical for business office atmosphere.
• Ability to handle a variety of repetitive tasks at a moderate level.
• Ability to occasionally handle electrical, mechanical, or equipment emergencies.