Patient Financial Counselor

1. Executes a comprehensive review of all cases meeting criteria, coordinates and performs patient/customer interview to define needs, develops and implements a strategy to enable the patient/customer to meet their financial obligation to Shenandoah Medical Center in a mutually satisfactory manner.

• Advocates for patients and family members and acts as a liaison with insurance companies and other third parties to assist in obtaining insurance and other financial information to secure financial approval for services.
• Confirms payer sources with close attention to coordination of benefits, identifies which contract/plan will provide payment for planned care.  Performs detailed financial screening of benefits.
• Determines benefit coverage to ensure that it meets the standards and explains the financial requirements to the patient or responsible party and arranges/collects appropriate payments per financial screening policy.
• Develops accurate point of service collections communication and facilitates the collection of these payments.
• Educate patients on billing processes, insurance terminology, and available financial resources.

2. Maintains current knowledge of rules and regulations of industry and government programs, hospital financial and billing policies and educates patients, families, team members and other staff as necessary.

• Maintains extended knowledge base of payer and billing requirements for federal, state, local and commercial sources.
• Maintains and expands knowledge base of web based applications used for determining eligibility.
• Participates in educational programs and in-service meetings to build upon current knowledge base.
• Maintains current, extended knowledge of hospital financial and billing policies.
• Acts as an educational resource for patients, families, the community and the hospital staff.

3. Acts as an advocate of behalf of patients and families to enable patients/families to take full advantage of services which may be available to them.

• Assists in locating resources and/or assistance programs for which uninsured/underinsured patients may be eligible.
• Informs patients and clinical teams of anticipated gaps and or lack of insurance coverage.
• Interviews patients and or family members in person: advises patient with regard to next steps or process for securing financial coverage.
• Assists patients and or family members in completing applications to applying for resources with external agencies or hospital financial assistance in an accurate and timely manner.
• Continues to serve as a point of contact for patients/families throughout the completion of processes.
• Keeps Manager apprised of exceptions, high grade complaints and issues in a timely manner.

4. Develops and maintains complete and accurate confidential patient financial records.

• Documents patient contacts and outcomes in the appropriate database in a thorough and timely manner.
• Follows HIPAA regulations and ensures that the confidentiality of patients’ medical, personal, financial records, employee records and organizational records is maintained.
• Establishes and maintains excellent working relationships with representative from insurance companies, government entities, Social Services, Utilization Management and Patient Financial Services.

5. Performs Financial Clearance

• Verifies eligibility and benefits for each patient
• Obtains prior authorization/pre-certification as required by payer
• Presents and completes patient waivers as required
• Documents all financial clearance notes, authorization numbers, and patient correspondence.
• Scans into the EHR system all necessary financial clearance documents
• Monitors and establishes payment plans
• Collaborate with registration, billing, case management, and clinical departments to ensure continuity of patient financial support.
• Assist patients with completing financial assistance and Medicaid applications.
• Provide estimates for services, procedures, and patient out-of-pocket costs when applicable.

6. Communicates effectively.

• Maintains close communication with billing offices and collaborates to resolve any billing and reimbursement issues. Facilitates resolution of patient billing issues.
• Shows patience and maturity when challenged by pressure and time restraints in resolving patient inquiries.
• Serves as a representative of the hospital, displaying courtesy, tact, consideration and discretion in all interactions with patients, coworkers and the general public in accordance with the Corporate Mission, Vision and Principles Statement.

7. Reporting and Monthly tasks

• Billing requests, billing edits, patient credits prior auths, claim denial, bad debt, and estimated preservice collections.

8. Customer Service and Communication Responsibilities

• Conduct difficult and sensitive financial conversations with professionalism, empathy, and confidence.
• Manage upset, emotional, or resistant patients while maintaining composure and professionalism.
• Utilize de-escalation techniques to resolve conflicts and improve patient understanding and cooperation.
• Clearly communicate payment expectations and financial policies, even in challenging situations.
• Demonstrate compassion while maintaining accountability to organizational financial guidelines.
• Handle confidential financial and personal patient information in accordance with HIPAA regulations
• Adapt communication style based on patient needs, emotional state, and health literacy.

 9. Performs other duties as assigned.