Patient Financial Coordinator/Certified Application Counsel

Area of Interest: Patient Services | FTE: 1.0 | Department: Financial Clearance | Shift: Monday-Friday Day Shift 8:00 AM–4:30 PM

Overview

The PFC/CAC assesses patients’ financial and insurance information in order to determine Medicaid, Marketplace, or other Community Programs or Resources. Assists with the actual insurance enrollment processes. Manages accounts that require a detailed, large-scope analysis of payment/insurance options in order to secure reimbursement. Handles active, unbilled, self-pay, and high-dollar inpatient and outpatient accounts.

Receives account referrals from Pre-access Department, Utilization Review Staff, Patient Access Staff, Physicians, Central Business Office Managers, and others for high deductible, out-of-pocket expenses, unresolved or pending claims, out-of-network procedures, and other financial risk issues. Counsels patients who have previous debt, poor payment history, are unresponsive, or uncooperative in implementing appropriate payment solutions.

Why UnityPoint Health?

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare for our commitment to our team members. Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few:

• Paid time off, parental leave, 401K matching, and an employee recognition program
• Dental and health insurance, paid holidays, short- and long-term disability, and more
• Pet insurance for your four-legged family members
• Early access to earned wages with Daily Pay
• Tuition reimbursement to help further your career and adoption assistance to help you grow your family

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together. We believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Responsibilities

• Obtain work daily by referral and by accessing Epic, work queues, reports, and daily house census
• Counsel patients via phone or in person, review patient’s previous accounts for outstanding balances, and financially counsel them on all payment options
• Monitor and work, on a daily basis, all self-pay accounts from assigned work queues
• Assess patient’s financial/insurance information to determine insurance eligibility
• Gather financial data to complete initial assessment
• Follow up with Department of Human Services and all other Public Agencies regarding application progress
• Review Department of Human Services decisions for enrollment in applicable states
• Ensure all follow-up with the Department of Human Services has been completed for and by the patient
• Assess patient/consumers for other Community Assistance Agencies
• Ensure all options have been exhausted prior to the patient qualifying for Financial Assistance
• Track financial impact of PFC/CAC Program
• Work closely with the CBO to ensure cohesiveness of processes and no duplication of efforts
• Communicate effectively with Case Managers to impact their plan of care
• Educate patients, employees, and physicians regarding Medicaid and Marketplace insurances that may be available
• Maintain excellent time management skills to ensure patients being discharged are counseled prior to handling other less “time-sensitive” responsibilities
• Maintain billing and collection tracking spreadsheets that capture patients and account disposition/resolution
• Complete and submit Medicaid and/or ACA Applications for patients that may potentially qualify in a timely and accurate manner
• Educate consumers/patients on Quality Health Plans, deductible, out-of-pocket, government subsidies, etc.
• Maintain extensive and current knowledge of Marketplace plans with Iowa and, if appropriate, Illinois, Nebraska, and Wisconsin exchanges
• Complete annual CAC Training for UPH as well as CMS
• Display all Certificates at all times when assisting consumers in office or in person
• Provide fair, impartial, accurate information to assist consumers when submitting the eligibility application
• Assist Registration in maintaining a working knowledge of a patient’s Medicare lifetime reserve days
• Educate the patient and obtain a consent form regarding their options
• Calculate and/or estimate expected charges, third-party payor portion, and patient portion
• Communicate insurance coverage and patient liability portions to patients or representatives
• Explain hospital credit and collection policies, payment options, and refer to Cashiers for account negotiations
• Assist patients in completing UPH Financial Assistance Application if necessary and forward all appropriate documents to the CBO
• Document actions in all appropriate computer systems; documentation must be thorough and include current account disposition and direction of future activities
• Perform follow-up and maintain all assigned work queue accounts
• Update patient insurance information in Epic as new data is received and communicate changes to appropriate parties
• Facilitate Cobra account appropriateness

Qualifications

• Education: High school graduate or GED equivalent is required
• Experience: One year previous experience in Patient Access or Billing required with demonstrated competency working with third-party payers to meet notification and pre-cert requirements. Knowledge of third-party payer processes and billing procedures required. Must have experience using computer-based software including Word, Excel, and Access databases, minimum typing of 40 wpm. Accurate data entry with numbers, letters, and the ability to spell medical terms correctly is required. Previous customer service is desired, but all staff members must have the ability to work with all age groups in a professional and positive manner
• Licenses/Certifications: Obtain MarketPlace certification within 6 months of employment and maintain this certification while in the position. Obtain Medicaid Presumptive certification within 3 months of employment and maintain this certification while in this position. Medical Terminology

Benefits

• Paid time off
• Parental leave
• 401K matching
• Employee recognition program
• Dental and health insurance
• Paid holidays
• Short- and long-term disability
• Pet insurance
• Early access to earned wages with Daily Pay
• Tuition reimbursement
• Adoption assistance