Financial Case Manager

Department: Financial Counseling
Location: Hybrid (Onsite & Remote) – Riedman Campus, 100 Kings Highway, Rochester NY 14617

About the Role

The Financial Case Manager is responsible for reviewing uninsured and under-insured patient accounts by following the insurance verification process. In the Community/Acute setting, the FCM assists under-insured patients by interviewing them and screening for secondary coverage options, applying for financial assistance, and other government-based programs. This role involves setting up interest-free payment plans and collaborating with Patient Financial Services to resolve minor coordination of benefits (COB) issues, including obtaining appeal documentation.

In the Long Term Care setting, the FCM assists residents in applying for and recertifying Medicaid coverage. This includes interviewing and screening residents and families for financial history, investigating and obtaining financial documentation from banking institutions, financial markets, life insurance agencies, pension programs, and investment firms. The role requires close collaboration with system and outside attorney agencies, as well as the Department of Social Services. All communication must foster positive patient relations and prompt reimbursement for services rendered. The FCM may also contribute to internal continuous improvement initiatives around financial performance and works collaboratively with multiple departments.

Responsibilities

Financial Counseling

• 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 accurate information for patient interviews when needed.
• Assists under-insured patients with applying for secondary coverage, financial assistance applications in the acute care setting, and other eligible programs.
• Completes all financial and secondary insurance applications with high-quality work, gathers necessary documentation, and submits them to the proper agency/staff for processing.
• Notifies appropriate staff of pertinent information and enters notes in a timely manner into the financial and clinical sections of Care Connect and other necessary software programs.
• Establishes payment plan arrangements for patients per policy for hospital and clinical accounts.
• Demonstrates thorough knowledge of the long-term care Medicaid program, including necessary forms, documentation requirements, agency regulations, and budgeting procedures for the Long Term Care arena.
• Follows documentation and productivity standards according to policies and procedures.
• Assists patients with resolving non-complex coordination of benefit issues and may contact third-party insurance providers to rectify primary and secondary coverage errors.
• Collaborates with Patient Financial Services staff by contacting patients to request completion of appeal documentation for acute-based hospital accounts.
• Tracks Private Pay residents in the Long Term Care setting to begin Medicaid applications at opportune times, ensuring no gap in coverage for nursing home care.
• Scans and saves applications and decisions into the system for future reference.
• Performs 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, anticipating the needs of those served.
• Collaborates with patients, their family/support persons, State or County staff, and/or other agencies to ensure patients receive eligible coverage in a timely manner.

Quality

• Ensures 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 and updates hospital and clinic accounts with plan code and insurance information.
• Ensures all accounts are 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.

Qualifications

• Associate’s Degree in a related field with two years of experience preferred, or an equivalent combination of work experience in financial counseling, long-term care settings, healthcare billing, or customer/patient service.
• Valid New York State Driver’s License (NYSDMV).

Skills

• For Community/Hospital setting: Completion of the Certified Application Counselor (CAC) training within 6 months of employment.
• Base knowledge of healthcare governmental assistance programs, guidelines, and application procedures.
• Effective interpersonal skills and ability to interact with 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 the Care Connect system effectively and accurately upon initial completed training.
• Skilled in establishing priorities to complete work in a timely manner despite changes in workload, deadlines, or competing requirements.
• 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.
• Proficient 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.
• 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 the service area.

Schedule

Full-Time, Monday to Friday, Day Shift (7:00 AM – 5:00 PM). Start times can be any time between 7:00 AM and 9:00 AM, and end times can be any time between 3:00 PM and 5:00 PM.

Pay

Pay Range: $21.00 - $24.50 per hour.

Physical Requirements

Sedentary Work – Exerting up to 10 pounds of force occasionally. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods.