Financial Counselor - Single Business Office - Full Time

Position Summary: 

The Financial Counselor is responsible for interacting with patients to ensure all avenues of reimbursement or assistance are pursued to guarantee payment for uninsured or underinsured patients. The financial counselor must use sound judgement and decision-making skills to ensure that all options for resolving open patient balances have been pursued.

The financial counselor gathers the required documentation to determine patient responsibilities and authorization requirements for specified home, office and hospital-based procedures and confirms that all processes related to insurance eligibility, authorization and verification are performed in order to discuss any financial responsibilities with the patient. The financial counselor is responsible for accurate and timely processing to make determination of eligibility for The Guthrie Clinic Charity Care Policy. Communications with the patient will be held prior to, at time of service or after services have been provided and will result in financial clearance, including collection of patient responsibility in full, the establishment of a payment plan or applicable financial assistance applications to determine the patient's ability to pay in accordance with Federal Income Guidelines and Financial Aid laws.  

Guides patients to establish a means of meeting their financial obligations in a manner which protects the financial standing of Guthrie Medical Group, Robert Packer Hospital, Troy Community Hospital, Towanda Memorial Hospital, Cortland Medical Center and Lourdes Hospital. 

Education, License & Cert: 

High School diploma or equivalent required. Associate's degree in business, Finance, Health Information Management or related field preferred.

Experience: 

Minimum:  One (1) year of experience in a customer service-related field    

Preferred:  One (1) year of experience in a healthcare, call center, business, financial or insurance related field 

Required Skills, Knowledge, and Abilities  

•Ability to work in a busy, loud, and demanding environment.  

•Must independently recognize and evaluate situations for the level of urgency.  

•Experience in providing a high level of customer service.  

•Strong emotional intelligence and empathy.  

•Excellent written and oral communication skills.  

•Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff, and the general public.  

•Must be detail oriented and accurate.  

•Ability to multi-task and prioritize tasks.  

•Displays an aptitude and willingness to learn new responsibilities.  

•Willingly accepts feedback.  

•Flexible and innovative.  

•Ability to problem-solve and work independently.  

•Displays a professional appearance.  

•Dependable and reliable in achieving goals.  

•Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.  

•Familiarity with medical terminology and abbreviations. 

Essential Functions: 

•Complete registration process, requests, updates and any other associated requests by any means necessary

•Manage patient insurance referral obligations, enter referrals and authorizations and link to appropriate upcoming appointments  

•Identify and confirm valid coverage for an episode of care and/or specific service and location: contact insurance companies and/or review electronic response summary and coverage discovery tool.  

•Verify that service is a covered benefit, based on knowledge of the specific insurance plan, the specific benefit package restrictions, and the timing of the service. Verify or obtain authorization for services as appropriate per insurance guidelines via phone, fax or online.

•Understand patient deductibles, OOP max, copays and coinsurances, out of network referrals, out of pocket limitations, and lifetime/event caps on liability. Refer patients to appropriate financial counsel based on financial coverage, financial situation, employment status, and liability. Review the account and timing of last patient demographic query to identify missing standard and/or required information. If necessary, contact the patient to complete the information.  

•Calculate patient liability before or at the time of service. Communicate the liability and explain the calculation.  

•Identify the potential need for assistance when the coverage/benefit is either inadequate or nonexistent for a medically necessary service, and if necessary, create a payment plan with the patient and document the agreement appropriately

•Communicate with patients and family members in person and by phone to explain fees for treatment, any applicable insurance coverage, and patient financial responsibility with respect to Guthrie Medical Group patient billing policies, payment arrangements, and eligibility of any external governmental need-based programs and internal need-based program.

•Confirm demographic information, verify eligibility and insurance benefits and coverage limitations to explain to the patient and review all current and estimated financial responsibilities. Determine if a patient may be eligible for any internal or external financial assistance programs and counsel and assist patient with completion of appropriate applications for those programs.

•Responsible for accurate and timely processing of applications in accordance with The Guthrie Clinic Charity Care Policy Guidelines and completion of Charity Care worksheet, and uphold strict confidentiality related to patient health information in accordance with HIPAA compliance.

•Responsible for validating all required financial information received and the completed Charity Care application, and uphold strict confidentiality related to patient health information in accordance with HIPPA compliance.

•Forward all completed information for eligible or ineligible applicants to CBO Director for final approval or denial and provide written notification to charity care applicants when a decision is reached regarding eligibility.

•Establish satisfactory payment arrangements for remaining balances after a charity care determination is made based on applicants' disposable income.

•Maintain and update daily the Charity Care excel reporting logs used to track all charity activity and ensure all participating Guthrie entities have access to current account information. 

• Answer automated call center calls and determine whether an outbound call is necessary, either to the patient or to the insurance company. For a call back, assess the call and respond appropriately, attempting to resolve all patient inquiries Customer Service Standards:  

•Support co-workers and engage in positive interactions.

•Communicate professionally and timely with internal and external customers

•Demonstrate friendliness by smiling and making eye contact when greeting all customers.

•Provide helpful assistance in anticipating and responding to the needs of our customers.

•Collaborate with customers in planning and decision making to result in optimal solutions.

•Ability to stay calm under pressure and deal effectively with difficult situations.  

•Assists patients with questions on existing statements, prior balances and/or billing questions.  

•Manages credits, statement holds, bankruptcy, deceased and recalls or returns from vendor agencies.  

•Promptly reports system issues to Coordinator and/or manager and provides feedback related to workflow process to promote efficiency. 

Other Duties: 

•Other duties as assigned.

Pay range:  $18.90-$29.50 

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Salary : $19 - $30