Financial Counselor

Under the direction of the Central Scheduling Manager, provides patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. The Financial Counselor creates estimates, advises patients on their insurance benefits and coverage, and in some cases accesses patient referrals for appropriateness. Ensures patient demographics are accurately updated, allowing for timely and efficient billing. The position requires the ability to plan and schedule and organize numerous tasks that directly impact hospital reimbursement.

RESPONSIBILITIES (ESSENTIAL FUNCTIONS):

• Review next day or next several days schedule to identify patients that will require benefit verification and pre-authorization.
• Call insurance company or use insurance website to verify eligibility and benefits.
• Save all insurance verifications from websites per departmental procedure.
• Obtain reference numbers and contact information when contacting insurance companies.
• Document eligibility and benefit information for each scheduled appointment.
• Call physician/provider offices for patients who are found “not eligible” at time of benefit verification and inform Manager.
• Review scheduled appointments and estimate payment amounts according to patient exam type and insurance plan.
• Calculate “bad debt” with DRH and adjust required payment accordingly.
• Verify if pre-authorization is needed when insurance is contacted or reviewed online.
• Verify that a pre-authorization has been done for the correct procedure and time frame includes scheduled procedure date.
• Assure an order is valid and includes all required information to meet CMS guidelines.
• Obtain new/corrected orders from physician/provider offices when necessary.
• Confirm scheduled procedure matches the physician/provider order.
• Prepare patient paperwork packets according to established departmental policy/needs.
• Provide complete patient packets to department timely and in accordance with departmental policy and procedure.
• Prepare journal for all required patient types according the departmental procedure.
• Complete patient insurance journal accurately.
• Indicate confirmed benefit eligibility and coverage on journal.
• Indicate amount that is to be collected prior to services being rendered.
• Notify registration staff of any special collection details.
• Provide collection note and requirements for registration staff.
• Print journal with all needed patient information and collection notes for registration staff.
• Save journal to patients account in the BAR comments.
• Save journal to CC journal file according to departmental guidelines.
• Provide written and verbal communication with co-workers and departments regarding any scheduling issues, collections, notes or special instructions for patient accounts.
• Document any other important communication for CWS staff and other Duncan Regional departments regarding the implementation of new procedures.
• Work with scheduling and registration staff to process same day MRI or CT add-ons as required regarding benefits and pre-authorization.
• Contact and counsel with patients to determine appropriate financial arrangements and requirements and the option for potential charity care and Medicaid eligibility according to policy and procedure.
• Offer instruction for Financial Assistance option when necessary.
• Contact self-pay patients prior to their scheduled exam to inform them of payment requirements and to make payment arrangements as required by each patient's situation but according to established policy and procedures.
• Escalate issues to the Manager as required.
• Appropriately report concerns of care and ethical issues.
• Ensure all patients are pre-registered in a timely manner, prioritizing registrations during periods of high volume according to departmental policy.
• Complete all registration fields for new patients.
• Verify existing patient demographic accuracy including insurance information and Medicare questions at time of pre-registration.
• Set priorities for routine work flow and makes allowances for special circumstances.
• Demonstrate time management.
• Act as a resource to enhance knowledge to other team members and physician/provider offices.
• Communicate timely and accurate information.
• Attend departmental meetings.
• Demonstrate an ability to be flexible, organized, and function well in stressful situations.
• Maintain a good working relationship both within the department and with other DRH departments and physician/provider office staff.
• Demonstrate essential aspects of teamwork by approaching relationships in a manner to reduce conflicts and minimize problems.
• Understanding of basic patient anatomy, radiology, cardio and surgery procedures.
• Understanding of modality safety procedures.
• Regular attendance and punctuality for scheduled shifts.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.
• Must adhere to safety protocols at all times.
• Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations.
• Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values.
• Performs other related duties as assigned.

Minimum Qualifications: Communication skills including fluency in oral and written English. Basic computer skills including the ability to send/receive email, navigate information technology associated with the position, and use Electronic Health Record information tools. Ability to remain flexible to quickly adapt to urgent situations. Ability to adapt procedures, processes, tools, equipment, and techniques to accomplish the requirements of the position.

Education and/or Experience:  High school diploma or equivalent required. Excellent customer service and verbal/listening/written communication skills required. Must be organized and have the ability to multi-task. Proven organization and time management skills are crucial. Maintains a level of productivity suitable for the department. Demonstrate and apply knowledge of medical terminology and high proficiency of general medical office procedures including HIPPA regulations. Excellent telephone etiquette and customer service skills. Prior scheduling experience preferred. Previous medical and insurance experience preferred. Knowledge of anatomy, physiology, or medical terminology preferred.

Certifications, Licenses, Registrations:  For those positions requiring travel, a current valid driver’s license and automobile liability insurance must be maintained.

Non Safety-Sensitive Position

As a condition of employment, vaccinations are required per DRH Policy. Medical and Religious Exemptions are available upon request.