Financial Counselor

Patient Account Quality Control Specialist

Contentnea Health is a Community Health Center providing comprehensive medical, dental and behavioral health services for members of our communities in Greene, Pitt and Pamlico counties in eastern North Carolina.

Performs the quality control function for patient accounts ensuring all pertinent information is available and accurately documented, allowing for timely and efficient billing and collection of patient co-payments, nominal fees and third-party payments.

Responsibilities and Duties:

• Supports patients in meeting their financial obligations by providing financial information and assistance.
• Assists patients with inquiries regarding account balances.
• Educates patients regarding available financial assistance programs.
• Provides Good Faith Estimates to patients upon request.
• Alerts Supervisor to negative trends identified through patient contact and direct observation.
• Performs collection activities in accordance with policy and procedure.
• Contacts patients to seek payment for unpaid self-pay balances.
• Educates patients on available financial assistance options including Sliding Fee Discount Program (SFDP) and payment plans.
• Sets up patient payment plans in Practice Management system and/or other payment platforms.
• Monitors payment plans for compliance.
• Terminates non-compliant payment plans.
• Completes patient pre-visit financial preparation in the Practice Management system in advance of scheduled appointments.
• Performs and documents pre-visit financial preparation processes within established department guidelines on expected processing timelines.
• Reviews patient profile to ensure appropriate documentation of insurance coverage, status, network status of scheduled provider, office visit co-pays, co-insurance, eligibility and/or limitations.
• Reviews patient profile to ensure appropriate documentation of SFDP eligibility for scheduled date of service, nominal fee or percent discount.
• Reviews accounts to identify and document unpaid self-pay balances for further collection efforts at check-in.
• Provides communication to patients regarding insurance documentation needs, re-certification requirements for the SFDP, outstanding balance, co-pay and/or nominal fee due at next appointment.
• Educates patients on the SFDP and encourages application prior to upcoming appointment.
• Documents in the Practice Management system follow-up activities identified during the pre-visit financial preparation to be completed by front desk staff during the patient check-in process.
• Provides eligibility assistance for the Affordable Care Act (ACA) health plans.
• Assists patients with completion of ACA health insurance marketplace applications.
• Documents assistance with ACA health insurance marketplace applications in the Practice Management system.
• Processes SFDP applications and re-certifications in accordance with departmental policy and procedure.
• Reviews applications for completeness and accuracy.
• Evaluates applications to determine eligibility.
• Documents eligibility in the Practice Management system.
• Uploads a digital copy of all SFDP applications to the Practice Management system.
• Notifies applicant of information needed to deem applications complete and accurate as needed and eligibility status upon determination.
• Notifies patients of expiring eligibility for the SFDP at least 90 days prior to expiration and advises on options to submit application in person or electronically.
• Prioritizes SFDP applications for immediate processing when received on the patient's scheduled date of service to ensure eligibility is updated in the Practice Management system prior to the conclusion of the patient's appointment.
• Processes all complete and accurate SFDP applications within established department guidelines on expected processing timelines.
• Assists patients with completion of Medicaid applications and updates to health plan and/or primary care assignment.
• Educates patients on use of the ePass system and the benefit of an enhanced account.
• Assist patients with ePass account creation and entry of data into the Medicaid application.
• Assists Medicaid recipients with completing and submitting Primary Care Provider Change Forms.
• Performs follow-up on Medicaid Primary Care Provider Change Forms collected during the prior month to confirm update to the beneficiary's assignment.

Qualifications and Skills:

• Possesses a basic level of written and verbal communication skills, computational and computer skills, and mathematical knowledge.
• Possess specific knowledge of sliding fee and payer processes and practices.
• Current ACA Certified Application Counselor certification.