Financial Counselor

PFS Financial Counselor

Are you passionate about quality and committed to excellence? Consider joining our Tidelands Health team. As our region's largest health care provider, we are also one of our area's largest employers. More than 2,500 team members at more than 70 Tidelands Health locations bring our healing mission to life each day.

A Brief Overview The Patient Financial Services Financial Counselor will perform administrative duties as it relates to the fiscal needs of the patients that we service. The PFS-FC will perform a variety of tasks related to patient needs and any relevant paperwork required to be completed in a timely manner. The PFS-FC is responsible for reviewing insurance processing for accuracy, reviewing patient statements to determine if payment and adjustments were applied appropriately and completing paperwork related to financial assistance, billing record requests, and insurance processing. Meet with patient or contact patient to confirm that they understand their patient statement, to determine patient financial assistance needs for medications or charitable care.

What you will do

• Qualify Patients for Financial Assistance. Working with all pure self-pay patients and insured patients who are responsible for a balance after insurance to gather, review, and evaluate the necessary and pertinent information regarding patient income and assets, and establish access to and utilization of government health coverage and/or charity care.
• Facilitate Financial Clearance. Facilitating the creation of individualized monthly installment plans for patients to pay off balances within the guidelines of the Tidelands Health collection policy.
• Utilize appropriate means to effectively communicate with customers. Utilizing a series of methods, including face-to-face meetings, telephone, and electronic/standard mail to establish and maintain contact with patients/guarantors.
• Document within Meditech, Quadax, eCW, Charity Guide or Verge. Employees should fastidiously record and maintain complete documentation of all activities performed on patient accounts in a timely manner.
• Utilize Charity Guide as a resource to progress Financial Assistance applications in a timely manner. Monitoring progress of applications to ensure adherence to application completion and processing timelines.
• Utilize Quadax, various payer websites and Meditech to validate insurance billing and processing occurred in a timely and appropriate manner. Review and resolve issues related to insurance processing to include, but not limited to, reviewing explanation of benefits from insurance payers, reaching out to denials team members for review of denials and/or rebilling of claims related to revision of order for services.
• Work in conjunction with various Tidelands Health vendors to resolve customer inquiries and grievances within a timely manner. Review of worklists from various vendors related to patient accounts questions regarding payment plans, paying off accounts or employee account payment, as necessary.
• Work with various department heads to resolve charge related complaints as well as the Patient Advocate to resolve quality of care grievances. Upon completion of department head and/or patient advocate review process appropriate rebill or adjustment necessary and contact patient to offer timely and effective resolution of their concerns.
• Assist with Patient Payment Portal Enrollment. When needed provide personal assistance to patients who express interest in enrolling in the patient payment portal.
• Report any repetitive issues to Assistant Director of PFS. Remaining in communication with manager regarding high-risk accounts and workflow trends and fluctuations.
• Complete cross training in all Tidelands Health PFS-ASC locations to better serve the varied patient population across the entire Tidelands Health service area(s). Rotation between work locations, as necessary, to ensure optimal coverage of all Tidelands Health PFS Business Services locations.

Education Qualifications

• High School Diploma with a minimum of five years healthcare experience Required
• Associate's Degree business related field and a minimum of three years healthcare experience Preferred

Experience Qualifications

• Two (2) or more years of experience in patient financial counseling, patient customer service, scheduling, or prior authorization
• Two (2) or more years of experience and/or knowledge of third-party payor regulations related to managed care, denials, and reimbursement issues

Skills and Abilities

• Ability to negotiate point of service payment.
• Ability to review and explain insurance processing per explanation of benefits when necessary.
• Ability to rebill insurance claims when necessary.
• Demonstrated ability to always exhibit exemplary core customer skills.
• Independent decision-making skills, collaborative abilities, and organizational and time management skills.
• Knowledge of third-party payor regulations related to managed care, denials, and reimbursement issues
• Knowledge of Terminology for hospital or physician billing required.
• Knowledge of interpreting and following detailed policies and workflows required.
• Knowledge of CPT and ICD-10 coding required.

Physical Demand Light Physical DemandThe intent of this job description is to provide a representative and level of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a contract for employment nor a declaration of the total of the specific duties and responsibilities of any particular position. Employees may be directed to perform tasks other than those specifically presented in this description.Tidelands Health is an Equal Opportunity Employer committed to providing employment opportunity without regard to an individual's age, color, disability, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, sexual orientation, or veteran status.