The Financial Counselor is responsible for performing financial clearance functions. These activities include generating weekly status reports, communication with multiple departments, monitoring accounts for proper documentation of third-party review notification, authorizations, insurance verifications, collection of deposits and self-pay balances, securing reimbursement methods of non-insured admits, computer update of accounts and the collection of verification of relevant patient data. This position facilitates resolution in disputed billing issues which require intense interaction with patients. This position also serves as subject matter expert in financial assistance policies, facility point of service collections and provides support on special projects.

Essential Duties as Revenue Cycle Manager:

· Follows policy and procedure in regard to financial screening, arrangement, and third-party demands.

· Conducts patient interviews to obtain demographic and financial data for registration, insurance verification, pre-certification and billing.

· Verifies and assures all accounts are ready for billing with adequate supporting documentation, within the established timeframes.

· Serves as support to patients and their family members to assure customers have access to all available funding, this involves; working with private as well as governmental agencies; i.e., private insurance, HMO/PPO’s, Medi-Cal, Medicare, Tricare and Worker’s Compensation.

· Records accurate patient demographic information when reviewing previous accounts and accounts with future dates of service.

· Follows and acts on several complex system policies (financial assistance, limited plan, point of service, out of network, etc.).

· Determines patients’ ability to pay and secure repayment arrangement with patient, according to SABHH established polices.

· Determines co-pay, share of costs and deductible status using information obtained during verification process.

· Documents accounting in billing revisions and notes to include verification, authorization, and co-pay to be collected

· Obtains and screens guarantor financial information for financial assistance and or refers patient to appropriate resource for public assistance programs.

· Provides estimates of procedures and services, calculates payment requirements, and negotiates pre-service payments according to financial clearance requirements.

· Establishes payment arrangements for future and previous services.

· Reviews future schedule to ensure pre-authorization and pre-payments have been collected.

· Assists with contacting physician office and patient in order to ensure pre-authorization and referral requirements are met prior to the date of service.

· Reviews and interprets explanation of benefits received from payers in order to assist patients and guarantors with understanding of claims processing or denial of services by payer.

· Upholds the Organization's ethics and customer service standards

This job description is not intended to be all-inclusive.

Employee may perform other related duties to meet the ongoing needs of the hospital.

Requirements

Education and/or Licensure – High School degree or equivalent required, Bachelor’s degree preferred.

Experience – 3-5 years Admitting or Financial Counseling preferred.

Additional Requirements – None.

Knowledge Skills and Abilities

· Proven ability to problem-solve, perform critical thinking.

· Requires good listening, interpersonal and communication skills, and professional, pleasant, and respectful telephone etiquette.

· Ability to maintain a professional demeanor in a highly stressful and emotional environment, to include crime, behavioral health and suffering patients in addition to life-or-death situations.

· Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.

· Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.

· Excellent data entry, numeric, typing and computer navigational skills.

· Basic computer skills and Microsoft Office and Excel.

· Has knowledge of governmental and managed care payer requirements.

· Demonstrates understanding of the various "Self-Pay" account classifications and their applicable patient statement processes.

· Understands the data elements required to generate a clean bill.

· Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.

· Knowledge of basic math and modern office procedures.

Physical Requirements/Environmental Conditions

Perform the following with or without reasonable accommodations:

· Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips.

· Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.

· Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound.

· Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects.

· Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze.

· Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic; ability to handle interruptions often and be able to move from one task to another

· While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.

Benefits

• Health Insurance
• Vision Insurance
• Dental Insurance
• 401K Retirement Plan
• Healthcare Spending Account
• Dependent Care Spending Account
• PTO Plan with Holiday Premium Pay
• Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
• Short and Long-Term Disability (with additional buy-in opportunities)