Financial Counselor

Patient Accounts Specialist

We are looking for a full-time/40 hours per week Patient Accounts Specialist to work in a fast-paced hospital business office. This position is responsible for the collections on assigned patient accounts by contacting patients, insurance companies, and third-party payors to resolve all outstanding balances and reconcile the account receivables/contractuals. This position is also responsible for the financial counseling of patients and their families. Verify all patient account insurance information within one business day of admission. Assures adherence to department quality and productivity standards, expected to work a minimum of 30 accounts per workday. Additional compensation is provided for achieving established team collection goals.

Patient Accounts Collection:

• Identifies and resolve any claim delay issues that impact collections.
• Follows up on payment errors, low reimbursement, and denials.
• Accurately interprets Explanation of Benefits (EOB).
• Initiates and tracks all appeals and reconsiderations as necessary.
• Resolves incarceration, third party liability, and coordination of benefits (COB) discrepancies.
• Works directly with the insurance company, provider, and patient to get a claim processed and paid.
• Utilizes insurance company provider portals, online chat system, and IVR phone system for claim resolution efforts.

Financial Counseling and Payment Coordination:

• Utilizes knowledge of healthcare reimbursement, medical insurance, and negotiating payment terms.
• Effectively determine and communicate insurance benefits and patient's self-pay responsibilities to patient/guarantor pre-admission.
• Monitors and reviews all new accounts and follow-up documents to determine the accuracy and completion of the information received from the Intake (A&R) Department.
• Contacts all payors to ensure clarification of insurance benefits and provide benefit education to patients, parents and guarantors.
• Meets with patients/guarantors in lobby and on treatment units to obtain up front deposits, set up payment plans, and complete financial paperwork.
• Daily maintenance of upfront collection spreadsheet.
• Investigate any delinquent patient information by timely contact with all third-party payor organizations and/or patients as necessary to identify any special circumstances affecting delay of billing and to ensure billing credibility.
• Prepares and maintains records and reports documenting the status of all insurance verification and upfront payment collections.

Additional Responsibilities:

• Creates an exceptional customer experience when handling inbound and outbound customer service calls efficiently while empathizing with customers and navigating systems in a fast-paced environment.
• Document detailed notes regarding all actions with appropriate message codes.
• Maintains current knowledge of all insurance verification policies and procedures and related legislation.
• Notifies the Business Office Director of any delinquent information.
• Promotes a positive working environment and guest relations.
• Promotes safety by attending mandatory in-services and complying with all safety measures initiated by the facility.
• Assumes and/or performs additional duties as requested.

Qualifications Requirements:

To perform this job successfully, an individual must be able to demonstrate competency in the criteria listed in this job description. Ability to work independently and part of a team. Experience with medical insurance. Working knowledge of Medicare/Medicaid regulations, policies, and procedures. Strong customer service, written/verbal, organizational, and interpersonal skills required. Computer literate/strong computer skills required - especially in Microsoft Word and Excel. The ability to maintain patient confidentiality. Requires ability to exercise independent judgement to accomplish goals and manage time efficiently to meet multiple deadlines. Successful completion of a background check and drug screen required for employment at Cedar Springs Hospital. Education/Experience: High school education or equivalent. A minimum of one (1) year experience in health care collections or related field, or any combination of education, training, or experience in a health care business office environment.