Pre-Admissions Financial Counselor

 POSITION SUMMARY

•    To collect payment on services rendered in a timely and efficient manner and to answering all inquiries from the patients in a courteous and timely manner.

 OVERVIEW

•    The evaluation is to assure individual performance, departmental goals and organizational goals are aligned. It is designed to support communication between the manager and the employee. Employee perception of their own performance is very important. To maximize the benefit of this process, both the manager and the employee participate in the evaluation process.

  QUALIFICATIONS

A.    Knowledge, Skills and Abilities

•    Excellent customer service skills.

•    Reads and understands the English language.

•    Ability to think critically and analytically with little or no supervision

•    Ability to work effectively in situations of high stress and conflict and communicate goals and outcomes.

•    Ability to process information and prioritize

•    Possesses exceptional verbal and written communication skills

•    Possesses independent work habits, is self-reliant and self-directed

•    Ability to learn, adapt, and change as required by the job functions

•    Ability to maintain absolute confidentiality of material and information accessed and reviewed

•    Basic computer literacy

•    Ability to move freely, reach, bend, and complete light lifting

•    Ability to use good body mechanics while performing daily job functions and ability to follow specific OSHA guidelines

•    Ability to maintain attendance to meet standard job practices

B.    Education

•    High School Graduate or G.E.D. required.

C.    Licensure

•    C.P.A.R. certification preferred.

D.    Experience

•    Minimum of five years experience is required in medical or financial field.

•    Pre-certification experience preferred.

E.    Interpersonal skills

F.    Essential technical/motor skills

G.    Essential physical requirements

•    Light: Exert up to 20 lb. of force occasionally and/or up to 10 lb. of force frequently - greater than 75%

H.    Essential mental requirements

I.    Essential sensory requirements

J.    Other

•    Basic understanding of Medicaid, Medicare and Commercial Insurance guidelines.

•    Analytical and organizational skills must be above average.

•    Attention to detail, communication, and documentation skills must be excellent.

•    Prior public relation experience is required.

•    Operations of computer systems and business machinery also required.

•    Must have the ability to communicate with patients in a courteous manner and possess excellent telephone communication skills with the ability to remain calm in difficult situations.

•    Must have the ability to talk with public in a professional manner and be able to interpret patient charges and explain in detail.

•    Must have excellent interpersonal communication skills and possess professional and neat appearance.

K.    Equipment used

 OTHER QUALIFICATIONS

A.    Exposure to hazards (body fluid exposure level)

•    Level III

B.    Age of Patient Populations Served

•    Infants 30 days - 1 year

•    Children 1 - 12 years

•    Adolescents 13 - 18 years

•    Adults 19 - 70 years

•    Geriatrics - 70 years

  JOB SPECIFIC DUTIES AND PERFORMANCE STANDARDS

•    Below are those tasks, duties, and responsibilities that comprise the means of accomplishing the position’s purpose and objectives. These are critical or fundamental to the performance of the position. They are the major functions for which the person in the position is held accountable. Following are the essential functions of the position, along with the corresponding performance standards.

•    Major Task, Duties, and Responsibilities

o    Responsible for pre-registering patients by telephone contact and verifying insurance benefits through use of internet, automated voice response and other integrated systems, prior to the patients arrival for testing.

o    Accurately updating patient demographic and insurance information as necessary.

o    Determines primary insurance liability in cases requiring coordination of benefits (spouse, dependent child).

o    Initiates communication to insurance companies to determine extent of coverage (if any), certification requirements and other co-payment provisions.

o    Explains to patients their estimated financial obligation and assists patients in determining the best method to meet their obligation, including advising patient of free and reduced charge program and application process.

o    Collects advance down payment on self-pay patients as defined in hospital's policy and procedures.

o    Collects co-pay and deductibles on commercial patients based on the insurance verification as defined in hospital's policy and procedures.

o    Reviews prior accounts and makes recommendations for their resolution as defined in hospital's policy and procedures.

o    Makes acceptable payment arrangements as stated in payment policy guidelines.

o    Refers potential Medicaid patients to Medicaid Benefit Specialist for screening process.

o    Notifies the physician's office of any potential delay or change in procedure due to certification requirements. Ensure all physician orders meet current standards and policies. Obtain clarification of orders from physician office.

o    Documents all contact with patients, family, employers and third party payers in the appropriate HIS system.

o    Continues to stay informed of any policy or regulation changes that could affect collection of receivables. Updates personal manual with current revisions of policies, reviews Communication Board and monitors electronic mail for current regulations.

o    Answers telephone professionally and courteously. Answers all inquiries in a courteous and timely manner.

o    Documents all patient complaints on a “patient complaint form” and forwards to the Customer Service Representative for review.

o    Understands the significance of the organization's Performance Improvement Programs and is an active participant.

o    Complies with all departmental policies of Patient Access. Including but not limited to the degree of accuracy of registrations.

o    Reports any problems to immediate supervisor daily as needed.

o    Responsible for any and all other functions as required and directed by Supervisor.

o    Coordinates scheduled absences with co-workers to provide adequate coverage for department.

o    Completes duties of the schedulers when needed.

o    Validates patient status per insurance requirements with type of procedures performed.

o    Coordinate patient flow with servicing departments to excel in customer service.

o    Review all procedures for medical necessity.

•    Accuracy

o    Maintains 95% accuracy rate or higher.

o    Notifies physician offices of pre-certification/authorization issues in a timely manner to prevent unauthorized procedures from being completed.

o    Completes minimum of 90% of pre-registrations of commercial visits with 100% accuracy for pre-certifications/authorizations.

•    Other duties

o    Complies with time and attendance policies. Attends to personal matters during breaks to avoid conflicts with work.

o    Follows proper chain of command for issues, complaints, etc.

o    Responds appropriately to department and facility codes.

o    Able to perform switchboard duties according to policies and procedures.

•    Ability to produce workable ideas and techniques, willingness to attempt new approaches and perform job duties independently.

o    Performs duties in an independent manner with minimal direct supervision.

o    Can solve day to day problems within scope of practice and make decisions in a timely manner.

o    Offers workable ideas, concepts and techniques to improve productivity.

o    Willing to attempt new job duties, tasks, etc.

o    Maintains regulatory requirements including all state, federal and Joint Commission regulations related to Patient Financial Services and, as appropriate, to the facility.

o    Performs any other task as requested by Supervisor or Management in a willing and positive manner.