Outpatient Financial Counselor

Position Summary

Under the general direction of PFC Manager, the Outpatient Financial Counselor (OPFC) helps vulnerable BMC patients access healthcare coverage and preserves BMC revenue by securing payors. The OPFC serves as an advocate and navigator, assisting patients in applying for financial assistance programs and securing healthcare coverage.

Essential Responsibilities / Duties

• Demonstrates respectful personal conduct and utilizes AIDET when engaging patients and visitors.
• Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually.
• Provides information about the full range of medical and dental insurance programs available through the Health Insurance Exchange (HIX).
• Interviews patients, in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify.
• Answers questions about Qualified Health Plans (QHP) and Qualified Dental Plans (QDP).
• Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co-pays, and deductibles when applicable.
• Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with the enrollment process.
• Provides in-person assistance at PFC office locations in Yawkey and Shapiro buildings, to offer outreach and education or initiate new applications or plan renewals for health insurance coverage.
• Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility.
• Scans MassHealth applications and supporting verification documents into HIX and patients’ Epic record.
• Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow-up efforts required to complete and submit for processing.
• For patients deemed ineligible for financial assistance programs, provides information regarding self-pay discount and payment plan options.
• Collections and posts payments for balances related to self-pay, Ad-Hoc, and Flat Fee contracts in accordance with BMC policy and procedure for collection practices.
• Interacts with numerous departments to resolve insurance and billing questions, e.g., Customer Service, Pharmacy, Social Service, Case Management, Patient Accounts, Clinic Staff, Unit Nursing staff, professional billing etc.
• Validates and updates active insurance coverage in the hospital registration and billing system on accounts with covered dates of service.
• Assists patients with billing questions or concerns.
• Validates and/or updates demographic and income information in HIX portal for “known” patients with prior history of program eligibility.
• Validates patients’ active insurance coverage and updates current plans in Epic.
• Collects and posts payments on accounts with outstanding balances.
• Maintains and closes Epic Cash Drawer and documents transactions in patients’ financial trackers.
• Schedules tasks for Financial Counseling Enrollment Coordinators, (FCECs) to conduct patient follow-up on pending applications to ensure that required documents are obtained and applications are completed and submitted timely to secure retroactive coverage.
• Protects patient and family confidentiality.
• Performs other duties and tasks as assigned.

Education

• High School diploma with 3-5 years of strong customer service experience in healthcare or human services setting required.
• Bachelor's degree strongly preferred.

Experience

• Work experience to include 2-3 years of strong customer service experience, preferably in a healthcare or human services setting.
• Bilingual persons and persons with hospital and/or healthcare experience strongly preferred.

Knowledge And Skills

• Demonstrates professionalism, maturity, and confidence needed to work effectively in a diverse, multi-cultural, and decentralized environment.
• Displays strong, consistent communication skills, (oral and written), interpersonal skill, and record keeping skills.
• Demonstrates knowledge and understanding of eligibility criteria and application process for programs offered through MassHealth, Health Safety Net, ConnectorCare, and BMC’s Charity Care Program.
• Displays strong organizational skills with ability to manage multiple tasks simultaneously; prioritize work assignments appropriately; and complete follow up task timely.
• Demonstrates strong work ethic and ability to meet performance goals for productivity and outcomes with minimal direct supervision.
• Demonstrates critical thinking and sound judgment in addressing and resolving barriers, issues, or concerns identified.
• Requires strong technical computer skills and proficiency in utilizing Epic and external database systems to research cases and successfully assist patients in securing active coverage.
• Displays exceptional customer skills and the ability to engage patients, family members, and team members respectfully, with empathy and cultural sensitivity.