Authorized Financial Counselor - CPAS Certified

Summary: Join a dedicated team as an Authorized Financial Counselor, where you will manage patient accounts and scheduling related to preadmission, admission, and additional procedures. You will interview patients to gather detailed demographic and financial information, verify insurance benefits, and initiate medical certifications. Your role includes reviewing medical necessity and ensuring proper authorization documentation is on file for procedures and patient status.

Key Responsibilities:

• Contact and interview patients, responsible parties, and insurance companies to secure insurance benefits for hospital or ambulatory services.
• Perform insurance eligibility and benefit verification using electronic data interchange (EDI), web access, and direct payer communication, documenting all information accurately.
• Determine the need for service authorizations such as pre-certifications and referrals, coordinating with payers, physicians, and case management as needed.
• Pre-register patients for upcoming visits, validating and entering demographic, financial, and insurance data.
• Validate medical necessity for Medicare and non-Medicare cases to ensure clinical and financial clearance.
• Communicate patient financial responsibilities, collect co-payments, co-insurances, deductibles, and outstanding balances at pre-registration or point of service.
• Provide financial education and assist patients with payment arrangements when necessary.
• Document payments and actions in the patient accounting system and issue receipts.
• Screen patients for market insurance and obtain signed physician orders for scheduled tests and procedures, ensuring proper electronic documentation.
• Follow up on insurance denials, initiating appeals or retro-authorizations as required.
• Assist insurance companies, physicians, and hospital departments with patient information in compliance with HIPAA guidelines.
• Maintain accuracy standards by working error reports daily and documenting collection efforts.
• Perform other duties as assigned.

Education:

• High school diploma or equivalent required.
• Associate's Degree in Business, Health Care Administration, or Computer Technology preferred.
• Patient Access Specialist certification (CPAS) required within one year of employment.

Experience:

• Minimum of one year insurance or clerical experience in a hospital or medical office setting.

Skills and Abilities:

• Strong knowledge of insurance processes and payment collection.
• Familiarity with medical terminology.
• Proficiency in Microsoft Office software.
• Excellent verbal and written communication skills, customer service orientation, and problem-solving abilities.
• Ability to manage complexity and stress while adapting to changing patient and organizational needs.
• Flexibility to work rotating shifts and varied days off as required.

Physical Requirements:

• Effective oral communication, visual, and auditory abilities to collect information.
• Manual dexterity to operate office equipment.
• Work environment includes office and call center settings with low to moderate noise levels.
• Ability to lift or move files and materials up to 50 pounds occasionally.

This position serves a diverse regional population in the Southeastern United States, providing essential financial counseling and support to patients navigating healthcare services.