Clinical Resource Counselor

Clinical Resource Counselor

Position Responsibilities:

The Senior Clinical Resource Counseling Associate is responsible for meeting with patients/guarantors, who require assistance in seeking and applying for healthcare funding (e.g., Charity Care, Medicaid, or other local/governmental funding program) and/or require assistance in reviewing and establishing payment options.

The incumbent works with patients beginning with the initial patient contact, via the pre-admit/pre-registration functions, and ending with the control and maintenance of the patient's account.

Functions as financial counselor for multiple patient types throughout the hospital for inpatient and outpatient activities.

Communicates with patients, family members/guarantors, 3rd party payers, local/governmental agencies, attorneys, employers, physicians/office staff and contracted vendors/agencies and various internal staff in the deployment of key activities.

Monitors reservation and scheduling information to initiate the financial counseling process on a pre-service, time-of-service and post-service basis. May interview patient and/or their representative either by telephone or in person to accurately update demographic, clinical, financial and insurance data. Reviews prior account notes for any information that might aid in the application/payment process, as well as documents all encounters and actions.

Ensures that all accounts are properly classified in the patient accounting system. Self-pay (uninsured) accounts will be screened within 24 hours of service, or next business day, with focus on high dollar accounts; high dollar patient liabilities, including outstanding balances; and under-insured accounts will be screened upon identification or upon patient/guarantor request.

Informs patient/guarantor of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances. May calculate patient liabilities and conduct credit scoring and propensity to pay modeling in order to determine their ability to pay for services. Provides financial education and outlines potential funding options, as appropriate.

Documents payments/actions in the patient accounting system and provides the patient with a payment receipt.

Seeks appropriate funding based upon patient requirements, collecting supporting documentation as required. Provides information and education to the patient and/or family member of the application process. Encourages patient participation in the application process and assists the patient in forwarding the required documentation and application to the appropriate funding agency.

Follows up on eligibility applications status and provides appeal assistance, as appropriate. Follows up on the collection of payments from settlements, payment arrangements, out-of-network settlements, and specialty services (e.g., cosmetic, worker’s compensation, auto accident, etc.) and determines course of action for non-cooperative patients (e.g., collections placement).

Investigates No Fault and Workers’ Compensation cases, retrieving police report and insurance information, as required

Works with contracted vendors/agencies to qualify applicants, reviewing each case prior to agency placement.

Assists staff in other departments including: Social Work Services in establishing Medicaid pending cases for placement in long-term care facilities or home healthcare, and UR/Case Management in documenting clinical information and soliciting assistance in clinical documentation from the medical staff.

Assists in identifying and obtaining funding for additional services required after discharge, establishing ongoing continuity of care counseling, and in discussing potential options for postponing or rescheduling care until funding is obtained.

Required Skills/Qualifications:

High school diploma or equivalent.

At least two (2) years prior work experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities is required.

Knowledge of insurance and governmental programs, regulations and application processes (e.g., Medicare, Medicaid, Social Security Disability, Tricare, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required.

Must have working knowledge of medical terminology and basic computer skills.

Must have a thorough knowledge of the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account, based on information obtained from the patient/family.

Job Type: Full-time

Pay: $25.00 - $30.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Vision insurance

Experience:

• Medical terminology: 1 year (Required)
• Hospital/Clinic Environment: 1 year (Required)

Work Location: In person

Salary : $25 - $30