Financial Counselor-Full Time-Days

Location: Fayetteville, North Carolina – Cape Fear Valley Medical Center, Department of PFS Financial Clearance

About the Role

Receives accounts and/or schedules for review and work-up regarding preadmission, admission, or add-on procedures and services. Interviews patients for necessary account follow-up to obtain accurate and detailed demographic and financial information. Verifies insurance information, benefits, and initiates medical certification; reviews medical necessity and ensures authorization is noted on file with supporting reference for the appropriate procedure, service, and/or patient status. Receives, reviews, and completes necessary follow-up for encounter denials. Notifies patients of financial responsibility; explains and reviews insurance coverage, and collects patient responsibility via phone or at time of service, including initiation of payment arrangements if needed.

Responsibilities

• Contacts and interviews patients, responsible parties, and insurance companies regarding hospital or ambulatory services to secure insurance benefits.
• Performs insurance eligibility/benefit verification using EDI transactions, web access, and direct calls to payers; documents information in the registration system with reference numbers.
• Determines the need for service authorizations (pre-certifications, third-party authorizations, referrals) and contacts payers, physicians, and/or case management/utilization review personnel as necessary. Ensures authorization matches tests ordered.
• Pre-registers patients for upcoming visits, validating and entering demographic, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) for Medicare and non-Medicare cases to ensure clinical and financial clearance.
• Contacts physicians/office staff for clarification if cases require diagnosis or procedure clarification.
• Informs patients/guarantors of liabilities and collects co-payments, co-insurances, deductibles, deposits, and outstanding balances at pre-registration. Calculates patient liabilities and provides financial education, referring to resource counseling as needed.
• Documents payments/actions in the patient accounting system and provides payment receipts. Assists with payment arrangements for remaining balances.
• Screens appropriate patients for market insurance.
• Obtains signed physician orders for scheduled tests and procedures and scans them into the electronic record.
• Completes follow-up on insurance denials and initiates appeals, retro-authorizations, etc., as needed.
• Assists insurance companies, physicians, practices, and hospital departments with patient information in accordance with HIPAA guidelines.
• Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting collection attempts.
• Meets or exceeds accuracy standards set by Patient Access Leadership.
• Performs other duties as assigned.

Requirements

• High school graduate or equivalent required.
• Associate’s Degree in Business, Health Care Administration, and/or Computer Technology preferred.
• Patient Access Specialist certification (CPAS) required within 1 year of employment.
• 1 year of insurance/clerical experience within a hospital or medical office setting.

Skills

• Proficiency in reading, writing, and speaking English.
• Knowledge of insurance processes and payment collection.
• Knowledge of medical terminology.
• Proficiency in Microsoft software.
• Excellent verbal and written communication, customer service, and problem-solving skills.
• Ability to handle complexity and stress in a dynamic healthcare environment.
• Flexibility to meet department hours of operation, including periodic rotation of shifts and regular days off.

Physical Requirements

• Ability to communicate orally, see, and hear to collect information.
• Dexterity to operate office equipment.
• Works in an office or call center environment.
• Subject to eyestrain due to prolonged CRT screen use.
• Low to moderate noise level.
• Regularly lifts or moves up to 10 pounds, frequently up to 25 pounds, and occasionally up to 50 pounds.
• Involves bending, reaching, pushing, and pulling file drawers.

Licenses and Certifications

• CPAS (Certified Patient Access Specialist) required within 1 year of employment.