Financial Counselor Diffs

Job Description

The Financial Counselor screens uninsured patients for Medicaid and financial assistance, and evaluates the patient's ability to pay for services. The Financial Counselor performs administrative and support activities relative to payment for services rendered to insured patients, including collecting co-pays, deposits, and insurance information. The Financial Counselor uses excellent customer service skills to interact with patients, family members, and visitors that call or enter the facility. The Financial Counselor performs the quality control function for Medicaid accounts, ensuring all pertinent information is available and accurately documented, allowing for timely and efficient billing.

Responsibilities

1. Customer Service
a. Greets visitors and patients upon entering the hospital in a caring and respectful manner. Introduces self to patients and families and lets them know he/she will be handling their financial matters.
b. Promotes and maintains cooperation and communication with other hospital departments, physician offices, patients, and insurance companies. Courteously handles telephone calls and faxes from above areas and assists these areas appropriately.
c. Serves as support to patients and their family members to assure customers have access to all available funding, which involves working with private as well as governmental agencies.
d. Serves as billing office customer service support in assisting patients/guarantors and employees with billing inquiries; to include payer benefits, EOB review, collections and establishing payment plans inhouse or vendor referral.
e. Assists patients with completing Medicaid and Financial Assistance application forms, along with obtaining insurance coverage via Heathcare.gov.

2. Payer Regulations
a. Facilitates the collection of patient payment for services rendered. Research charges to obtain an approximate cost of procedures and communicates this information to the patient. Verifies insurance eligibility, if any.
b. Informs the patient of hospital policies and procedures regarding the financial responsibility of the patient. Establishes payment arrangements according to departmental policy and obtains signature on Financial Agreement Form. Collects the patient's payment and documents the payment in the patient's record.
c. Screens patients who present as self-pay to determine if patient has active insurance coverage prior to initiating interview for financial assistance and other governmental programs, based on internal program guidelines or state and federal payer regulations.
d. Performs follow up activities relating to pending Medicaid and/or financial assistance, including follow up calls and letters to the patient and status inquiries to the Division of Medicaid. Ensure timely resolution.
e. Reviews weekly status reports, monitoring accounts for proper documentation of Healthy Louisiana Medicaid plans. Communicates with multiple departments to obtain pertinent data needed for approvals and authorizations.
f. Maintains daily contact with Utilization Management, Business Office, Patient Registration, Medical Records, Ancillary departments, physician offices, and other outside entities.
g. Monitors appropriate turnaround on all accounts to ensure determinations are made and notification provided to the patients within established timeframes.

3. Receivables
a. Submits daily cash receipts timely and accurately. Knows and understands hospital collection policies.
b. Reads and understands Explanations of Benefits. Follows up on calls from patient inquiry within 24 hours. Reviews patient's account history for any outstanding balances due and discusses payment options with the patient.
c. Maintains accountability and control of accounts to assure that reimbursement is received and there is no financial loss due to errors.
d. Maintains knowledge of payer contract terms and enforces/applies the knowledge when calculating patient's financial responsibility.
e. Demonstrates good decision-making skills, reflecting a balance between mission and financial obligations.
4. Other Duties as Assigned
a. Performs other duties as assigned or requested.

Qualifications

Education: High School Diploma or Equivalent

Experience: 2 years healthcare experience, preferably in Access Services or Business Office