Financial Case Manager

Financial Case Manager

The Financial Case Manager is responsible for reviewing uninsured and under-insured patient accounts by following the insurance verification process. Community/Acute - The FCM will assist under-insured patients by interviewing patients and screening for secondary coverage options, applying for financial assistance and other government based programs. This person assists patients with setting up interest free payment plans and work closely with Patient Financial Services to help resolve minor coordination of benefits (COB) issues that include obtaining appeal documentation. Long Term Care The FCM will assist residents in applying for and recertifying in Medicaid coverage. This entails interviewing and screening resident and family for financial history, investigating and obtaining financial documentation needed from but not limited to banking institutions, financial markets including life insurance agencies, pension programs, and investment firms. This person will work closely with system and outside attorney agencies as well as the Department of Social Services. All communication must be conducted in a manner that will result in positive patient relations and prompt reimbursement for services rendered. The FCM may also help in internal continuous improvement initiatives around financial performance. This individual works collaboratively with multiple departments of our organization

Key Responsibilities:

• Assesses the healthcare coverage needs of uninsured and under-insured patients.
• Verifies insurance coverage to identify uninsured patients who may be eligible for insurance enrollment, and provides the FCM II accurate information for patient interview when needed.
• Assists under-insured patients with applying for secondary coverage, financial assistance applications in the acute care setting and other programs in which they be eligible.
• Complete all financial and secondary insurance applications with high quality work, gathers all necessary documentation and submit them to the proper agency / staff for processing.
• Notifies the appropriate staff of pertinent information and enters notes in a timely manner into the financial and clinical sections of Care Connect as well as any additional software programs that may be deemed necessary for the arena working in.
• Establishes payment plan arrangements for patients per policy for hospital and clinical accounts.
• Thorough knowledge of long term care Medicaid program including necessary forms, documentation requirements, agency regulations and budgeting procedures for Long Term Care arena.
• Follows documentation and productivity standards according to policies and procedures.
• Assists patients with resolving non-complex coordination of benefit issues. May need to contact third party insurance providers to rectify primary and secondary coverage errors.
• Collaborate with Patient Financial Services staff by contacting patients requesting they complete appeal documentation for the acute based hospital accounts.
• Track Private Pay residents in Long Term Care setting in order to begin Medicaid application at opportune time as to ensure no gap in coverage for nursing home.
• Scanning and saving applications and decisions into system for future reference
• Additional duties as assigned with a positive attitude.

Customer Service

• Conveys courtesy, dignity, respect, and a positive attitude with all individuals.
• Demonstrates kindness and empathy when interacting with patients, family and visitors and is able to anticipate the needs of the people we serve.
• Collaborates with patients, their family/support person(s), State or County staff, and/or other agencies to ensure patients receive the coverage they are eligible for in a timely manner.

Quality

• Ensure timely completion of release of information forms, patient financial information, financial obligations, and other applicable Rochester Regional Health forms per policy.
• Verifies guarantor and resident information for accuracy.
• Updates hospital and clinic accounts accurately with plan code and insurance information.
• Ensure all accounts documented timely with accurate and complete information.
• Maintains accurate spreadsheets and databases per department standards.
• Completes organizational and state (NYS of Health) required training programs.
• Ensures compliance with privacy and security standards per Rochester Regional Health policies and procedures.

Desired Attributes:

• For Community/Hospital setting: Completion of the Certified Application Counselor (CAC) training within 6 months of employment.
• Base knowledge of health care governmental assistance programs, guidelines, and application procedures.
• Able to communicate and respond to inquiries; requires effective interpersonal skills and ability to interact with the patients to explain payment policies and persuade patients to settle account balances.
• Ability to manage multiple concurrent assignments in a fast-paced environment.
• Ability to utilize Care Connect system effectively and accurately upon initial completed training.
• Skilled establishing priorities to complete work in a timely manner despite changes in workload, deadlines, or competing requirements.
• Demonstrate strong interpersonal and organizational skills to interact courteously and effectively with physicians, patients, and staff members.
• Ability to interact with all members of the organization in ways that enhance understanding, respect, cooperation and problem solving.
• Writing and editing skills to prepare grammatically routine business correspondence; such as email and letters.
• Skilled in operating a PC and PC-based software applications, including Microsoft Office.
• Ability to solve problems with minimal direction in a stressful environment and maintain a positive attitude.
• Demonstrate excellent time management, organizational, verbal, and written skills.
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner.
• Ability to maintain confidentiality of all medical, financial, and legal information.
• May need to travel throughout service area.

Minimum Qualifications:

• Associates Degree in related field with two years of experience preferred or an equivalent combination of work experience in financial counseling, long term care setting, healthcare billing or customer/patient service is required.

Required Licensure/Certification Skills

• None

Rochester General Health System is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran.