Financial Counselor - Decatur (U) (4583)

About the role

This position works on site at the Federally Qualified Health Center (FQHC) and serves as a financial counselor to patients. The position is responsible for assisting patients in obtaining medical coverage and for qualifying and enrolling patients for coverage through the Affordable Care Act either with Medicaid or through the State of Illinois Insurance Exchange. This position will also analyze patient information to ensure correct documentation. This position is ON SITE only.

Responsibilities

Patient Coverage/Eligibility (50%)

• Enforce and implement FQHC federal rules and regulations regarding eligibility for patients with no insurance to qualify for Medicaid, Medicare, insurance through the Marketplace, or other available options.
• Serve as the on-site primary contact for the 340B program.
• Assist patients in finding affordable options to fill prescriptions for both emergent and maintenance medications.
• Maintain required certifications for Assisters at both state and federal levels.
• Track and monitor all incoming patient assistance forms; review for completion, ensure patient is notified appropriately, and ensure forms are scanned into the patient's record.
• Assist patients in completing applications, review patient applications and financial statements, and inform patients of required personal financial statements and documents.
• Document notes and adjustments in the practice management system to keep patient's account accurate and up to date and to inform others who may access the account.
• Document notes in the EHR, as appropriate, and in the FQHC financial tracking sheet in a timely manner.
• Assist patients by providing appropriate information to apply for coverage through the appropriate plan or assist them to apply on-site.
• Keep detailed records including patient's application for assistance and patient's financial statements.
• Serve as a liaison between providers, pharmacies, and insurance agencies to facilitate resolution of escalated, complex healthcare navigation.
• Prepare weekly report for Administrator including numbers of applications reviewed, numbers approved, and number of patients who qualify for plans by percentage of poverty level.
• Keep abreast of other coverage options for patients (e.g., Illinois Breast and Cervical Cancer Program (IBCCP), Planned Parenthood, Local County Health Department, and others).
• Respond to a variety of questions from physicians, hospitals, government agencies, insurance companies, and related interested parties concerning the status of insurance benefits.
• Attend workshops and seminars conducted by the Illinois Primary Health Care Association and the State of Illinois to stay informed.

Financial Counseling/Collections (30%)

• Handle patient requests on-site or by telephone regarding billing process and inquiries; make appropriate entry of actions taken in the practice management system.
• Master the use of internal and external systems: Internal: IDX, TouchWorks EMR; External: Abe.Illinois.gov, Healthcare.gov, State of Illinois MEDI System, Medicare Plan Finder.
• Attend relevant webinars or trainings to relay information and provide updates.
• Keep abreast of online updates from HFS, CMS and forward important information to appropriate units affected (e.g., new approved drug lists, changes in payments for certain services).
• Use guidance from CMS and other national partners to identify vulnerable populations and develop outreach strategies.
• Leverage network of community partners and relevant social media tools to conduct outreach educating the public about Open Enrollment, health insurance concepts, the FQHC program, and the healthcare system at large.
• Perform eligibility checking using MEDI as needed.
• Other duties as assigned by Health Care Administrator.

Referrals and Prior Authorizations (20%)

• Assist in completing patient referrals and external preauthorizations.
• Assist patients with securing referrals to specialist physicians, health care agencies, and hospitals.
• Work with managed care organizations and the physician's office, providing appropriate documentation for referrals, authorizations for hospital, testing, or other services.
• Determine and disseminate required information from the patient's medical records (chart notes, school physicals, laboratory results, x-rays, etc.) to assure medical necessity of the request to the consultant and/or insurance/managed care company.
• Help maintain up-to-date directory of services provided to SIU Center for Family Medicine Decatur patients by specialists and health care agencies.
• Contact managed care companies concerning status of referrals and preauthorizations.
• Keep faculty physicians, resident physicians, nurse practitioners, physician assistants, nurses, and other staff informed about requirements and medical necessity guidelines of managed care referrals and authorization requests.
• Provide feedback regarding development of appropriate forms for internal and external use as it relates to referrals and preauthorizations.
• Maintain ability to appropriately handle referrals, schedule appointments, answer general patient questions; be knowledgeable about procedures and services.
• Maintain up-to-date knowledge of Medicare, Medicaid, and Managed Care Guidelines.
• Help monitor referral reports and assist with timely follow-up in accordance with policy and procedure.
• Enter referral and preauthorization information into the electronic medical records and computer system according to policy and procedure.
• Maintain operating knowledge of systems: IDX, TouchWorks, MEDI, EPIC, and dbMotion.

Qualifications

Credentials to be Verified by Placement Officer

Any one or combination totaling two (2) years (24 months) from the categories below:

• College coursework in a health-related