Lead Patient Financial Counselor

Exemption Status: Non-Exempt

Pay

Hiring Range: $17.36 - $31.26. The final offer may vary within this range based on a candidate’s experience, skills, qualifications, and internal equity considerations.

This position may have a signing bonus available; a member of the Recruitment Team will confirm eligibility during the interview process.

Schedule

• Monday through Friday
• Scheduled Hours: 8:00am - 4:30pm
• Shift: Day Shift, 8 Hours
• Hours: 40 per week

About the Role

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence, and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where you can build the career you deserve. We are more than 20,000 employees working together as one health system in a relentless pursuit of healing for our patients, community, and each other.

Under the general direction of the Financial Counseling Supervisor/Manager and/or Financial Clearance Director, the Lead Financial Counselor (Certified Application Counselor) provides functional oversight to an assigned group of Financial Counselors for the process of providing health care coverage needs assessment with patients, community applicants, and family members.

Responsibilities

• Distributes and monitors the flow of work for an assigned group of Financial Counselors.
• Prioritizes work in a high-volume, fast-paced, team-oriented environment.
• Interviews, screens, and assesses applicants and family members in various on-campus locations, utilizing income, household composition, and other criteria in accordance with CMS and other governmental guidelines for program eligibility.
• Determines qualification for affordable health insurance coverage, including the application of advance premium tax credits (APTC), premium assistance programs, Medicare Savings Plans, and any other eligible programs.
• Interacts with patients, the community, and outside agencies in a professional manner aligned with the Mission and Vision of UMMHC.
• Facilitates enrollment through the online Health Connector Health Insurance Exchange (HIX) or other program applications by accurate and timely submission of necessary paperwork according to state and federal regulations.
• Follows up with patients in person or by telephone to obtain appropriate confidential financial and medical information for incomplete applications to establish eligibility for various financial assistance programs.
• Acts as the liaison for patients with MassHealth, the Health Connector, and the Health Safety Net to assist in resolving eligibility discrepancies, application status updates, and other issues arising in the determination process.
• Facilitates patient understanding of health access options, including eligibility rules, coverage types, enrollment periods, and available products/plans through MassHealth, the Health Connector, Medicaid Managed Care, and the Health Safety Net program.
• Covers the Financial Counseling call center to act as a resource for patients, families, community members, clinical departments, and other Revenue Cycle departments regarding insurance coverage issues and questions.
• Provides and documents price estimates for patients in accordance with federal price transparency regulations.
• Works within EPIC work queues to identify and reach out to uninsured/underinsured patients/families (inpatient, outpatient, surgical day, psychiatric inpatient/outpatient, etc.) to screen for assistance programs and upgrades to richer benefit programs.
• Collaborates with clinical areas, interpreters, social workers, case managers, social security outreach workers, drug assistance coordinators, enhanced benefit coordinators, care mobile, physician/provider offices, and community health centers to ensure access to care and timely discharge planning.
• Discusses financial obligations with patients prior to elective surgical days or admissions and communicates all information to provider offices and other Revenue Cycle departments.
• Updates all accounts to reflect the current account status, including appropriate financial class, eligibility dates, and other patient financial and demographic information.

Standard Staffing Level Responsibilities

• Distributes and monitors the flow of work for an assigned group of employees.
• Provides training and technical assistance to employees within the assigned work area.
• Assists the supervisor in ensuring assigned employees are provided with appropriate resources, materials, and methods.
• Provides recommendations to the manager or supervisor for the most efficient utilization of assigned personnel.
• Relays work instructions from the supervisor.
• Provides direction, guidance, and leadership in the absence of the supervisor.
• Complies with established departmental policies, procedures, and objectives.
• Attends a variety of meetings, conferences, and seminars as required or directed.
• Demonstrates the use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to a professional, tolerant, and civil environment for all employees, patients, and visitors.
• Maintains regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

Requirements

• Associate’s Degree in Business, Social Services, or three years’ experience in healthcare, accounts receivable, or a related function.
• Certified Application Counselor (CAC) certification.
• Completes annual recertification and all mandatory ongoing training provided by the Massachusetts online Learning Management System.
• Complies with privacy and security regulations that meet all federal program standards.
• 3 years’ experience in healthcare, accounts receivable, Financial Counseling, medical billing, or a related field.
• Proficient in department collection practices and concepts of third-party, bad debt, and free care regulations.
• Excellent written and verbal communication skills to effectively interact with various levels, including patients, hospital, and medical staff.
• Effective communication and customer service skills, both verbal and written.
• Ability to use specialized applications software and computer systems for patient registration and scheduling.
• Ability to work independently with strong problem-resolution skills.
• English speaking, reading, and writing skills.

Preferred Qualifications

• Bilingual speaking and reading skills.

Unless certification, licensure, or registration is required, an equivalent combination of education and experience that provides proficiency in the areas of responsibility may be substituted for the above requirements.

Physical Demands and Environmental Conditions

• Work is considered light with frequent walking throughout the day.
• Must be able to cover other campuses if warranted.
• Must provide own transportation.
• Position requires work indoors in a normal office and/or patient care environment.