Under the direction of the Department Director/Manager/Supervisor, the Financial Counselor are responsible and accountable for providing and reviewing all in-house patients, out patient Observations and other outpatient services for financial disposition which includes financial counseling, interviewing to determine eligibility of available assistance programs and completion and filing of all necessary documents.

PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

1. Maintains, reviews and controls daily in-house admissions documents daily.


2. Updates, changes or adds demographic and billing information in the EPIC system.


3. Provides financial counseling to uninsured patients for financial disposition of accounts by determining what programs the patient may qualify for (50% discount, Helping Hand Loan, monthly payment plan or Helping Heart).


4. Works to obtain approval for pending Medicaid and all other payor solutions (COBRA, Works Comp, Auto, and Sex/Violent Crimes).


5. Prepares appropriate documents based upon current payer/hospital guidelines for all third-party payers for approval.


6. Phones patients to obtain insurance and COB information, inform them of financial responsibility and discusses various payment options.

JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES


• Review and analysis outstanding balances on all accounts and determine the next action to be taken. (Example: insurance follow-up, patient follow-up, adjustments, bad debt referral etc).


• Pursue appeal process on applications denied inappropriately (All eligible payor sources)


• Verifying patient benefits


• Actively pursue approval from insurance companies using telephone calls or letters.


• Actively pursue payment from patient/guarantor on all outstanding account balances after third party payment or rejection.


• Discuss various payment options or financial program if needed.


• Work delinquent patient balance accounts, recommending appropriate disposition such as bad debt referral or write off adjustment as needed to management.


• Update EPIC systems on all accounts that need billing to insurance.


• Update EPIC all patient demographic corrections as needed.


• Handle and resolve problem accounts, recommending appropriate disposition if needed to management.


• Handle any phone calls or patient walk in's and resolve or refer to appropriate personal any issues.


• Document all activity done on each account on the EPIC system


• Enter the proper billing indicators/ account note types on each account work for productivity tracking.


• Knowledge of UB-04 and 1500 billing preferred.


• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.


• Ability to prioritize job functions, work independently and exercise good judgment.


• Must possess good written and verbal communication skills.


• Must possess good organizational/analytical skills and mathematical aptitude.


• Proficient use of calculator and minimum typing (55 wpm).


• Basic personal computer skills.

EDUCATION

• High School Diploma/GED Equivalent Required


• Associates Business Management Preferred


• Additional post high school educations can be substituted for the work experience requirement on a year for year basis.


• 2 Healthcare/Medical - Business Office Required

STANDARDS OF BEHAVIOR

Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.


CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE

Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.


DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.