Financial Counselor-Full Time-Days

Summary

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 assures that authorization is noted on file with supporting reference for the appropriate procedure, service, and/or patient status.

Major Job Functions

• Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits.
• Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.
• Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered.
• Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Contact physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).
• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.
• Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance.
• Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record.
• Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed.
• Aids insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.
• Maintains accuracy of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation.

Minimum Qualifications

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

Knowledge, Skills, And Abilities

• Proficiency in reading, writing, and speaking the English language.
• Knowledge of insurance and collection of payments.
• Knowledge of Medical Terminology.
• Knowledge of Microsoft software.
• Excellent verbal and written communication skills, customer service skills and problem-solving abilities.
• Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
• May be required to periodically rotate shifts and regular days off.

Physical Requirements

• Must be able to communicate orally, see, and hear to collect information.
• Must have dexterity to operate office equipment.
• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.

Required Licenses And Certifications

• CPAS - Healthcare Business Insights

Position Details

• Cape Fear Valley Health System is an Equal Opportunity Employer.