Financial Counselor

Primary Function

Understands the importance Einstein Healthcare Network places on providing exemplary customer service and performs job functions in a manner that helps meet the department customer service goals. Identifies customer service issues and resolves or initiates necessary follow-up.

Responsibilities

• Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information.
• Explains necessary forms and obtains signatures from patient/guarantor.
• Utilizes appropriate reports to contact insurance payers, verifying benefits and obtaining necessary authorizations.
• Documents authorization and benefit information in registration system.
• Work with payors to resolve accounts that are pending or denied.
• Screens patient/guarantor for federal, state, county or other assistance programs and completes necessary forms and applications per facility guidelines.
• Explains insurance benefits and collects current and outstanding co-pays, deductibles and self-pay portions due or establishes payment arrangements for these balances as appropriate.
• Maintains a working knowledge of third-party reimbursement requirements and regulations.
• Exhibits working knowledge in the use of all registration and scheduling systems, electronic verification tools and Web based resources.
• Follows Patient Financial Services self-pay policies including self-pay fee schedules, completion of Medical Assistance and Charity Care Application, explanation of payment options and collections of monies due.
• Follows Patient Financial Services policies related to cash handling and performs department cashiering functions and point of service transactions.
• Maintains understanding of the medical necessity screening process and appropriate systems and a working knowledge of ICD-10 and CPT codes.
• Performs appropriate pre-registration functions including calling physician offices, insurance payers and the patient/guarantor, as necessary.
• Cross-trained with appropriate knowledge and skills necessary to staff multiple areas within department, including but not limited to Diagnostic/Interventional, Admissions, Cashier, Pre-Registration, Scheduling and Emergency Department.
• Participates in training of new team members.
• Work closely with Nursing, Ancillary, Scheduling, Case Management, Social Workers, Managed Care Companies, Physicians, Administration and Patient Accounting.
• Maintains departmental logs for statistical reporting.
• Works departmental reports as assigned.
• Consistently meets Quality Assurance standards set by Patient Financial Services department.
• Mets departmental goals regarding collections, productivity and customer service.
• Participates in internal department committees.
• Assists his/her manager in planning and organizing department activities.
• The Financial Counselor/MA Specialist interviews in-house patients referred for Medical Assistance applications.
• Obtains various paperwork from patients and other hospital departments that are necessary to secure applications according to MA regulations.
• Work with County Assistance office and referral agencies to obtain Medical Assistance approvals.
• Process and perform system maintenance pertaining to PA 162 forms.
• Work with Case Management to insure MA 87s are processed according to MA regulations.
• Provide support for MA biller.

Requirements

• High School diploma or equivalent
• Two (2) years’ experience in a financial, business office, or customer service environment required.
• One Year Hospital Business Office Experience Required
• Demonstrated computer skills (including Microsoft Word and Excel).
• Working Knowledge of ICD9 coding and medical terminology.
• Able to work with minimal supervision.
• Well organized, self motivated individual with a positive attitude.
• Excellent customer service skills.
• Able to work effectively with all payor and hospital personnel

Qualifications

• Education/Training/Experience

High School diploma or equivalent

Two (2) years’ experience in a financial, business office, or customer service environment required.

One Year Hospital Business Office Experience Required

Demonstrated computer skills (including Microsoft Word and Excel).

Working Knowledge of ICD9 coding and medical terminology.

Able to work with minimal supervision.

Well organized, self motivated individual with a positive attitude.

Excellent customer service skills.

Able to work effectively with all payor and hospital personnel