Sr. Financial Counselor | Patient Eligibility

Job Family:

Admitting Representative

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Sr. Financial Counselor will support the team by serving as a subject matter expert, responding to team member inquiries while being a resource for routine administrative tasks for department leadership. This role will help monitor patient accounts for accuracy and follow through of work assigned to the team while assisting with escalations from team members.

Responsibilities and Duties:

• Determine patient responsibility and eligibility through Insurance, Federal, State, and/or County government benefits. Review accounts for proper plan codes, financial class, and patient type.

• Contact appropriate agencies to verify assumptions of liability.

• Negotiate flat rates on accounts where the patient has no linkage to government programs.

• Meet with patients at bedside to inform them of financial responsibility prior to discharge.

• Set up payment plans with patients prior to discharge and document payment arrangements in patient accounting systems. Provide mailing envelopes and payment dates to patient before discharge.

• Collect monies from patients when there is an estimated patient liability due on the account.

• Monitor Medicare days and co-insurance days on in-house patients. Review all in-house Medicare accounts on the 1st and 15th of each month. Update account with Eligibility info in detail.

• Document all payer and patient financial information in the hospital computer system.

• Retrieve Inpatient Census patient information within the facility to follow up on In House patients not insured or under insured.

• Obtain complete and accurate patient information including possible insurance(s), and financial information by communicating with patients, family members, and physicians regarding their stay.

Coordination Assistance:

• Serve as a backup in coordinating with Financial Counselors and supervisors to address escalated issues in the absence of more experienced coordinators.

• Provide support by gathering information, preparing basic reports, and following up on pending account items.

• Assist in coaching and training new/existing Financial Counselors on routine account procedures and workflows under the guidance of department leadership.

• Communicate daily with co-workers, hospital and management regarding account progress and/or other issues.

• Utilize organization and prioritization skills in daily tasks to ensure completion of daily processes.

• Maintain open and positive professional communication orally and written at all times.

Program Identification and Application Submissions:

• Manage the identification, submission, and re-submission of basic claims to ensure adherence to proper application guidelines.  

• Assist in identifying applications, billing discrepancies, and communicating findings to management for resolution.

• Monitor low-complexity account trends and provide input on potential process improvements.

• Ensure compliance with all applicable regulations, policies, and procedures.

Operational Support:

• Provide general support for departmental initiatives and projects.

• Participate in team meetings and provide input on standardizing operational practices.

• Represent department on weekly calls with clinical staff to provide updates on eligible patient programs and status.

• Create reports, workflows, and job aids

What You Will Need:

• High School Diploma or equivalent (relevant experience may be substituted for formal education)

• 3-5 years of experience in Patient Eligibility and/or Financial Counseling

• Strong knowledge in Healthquest, Advocatia, and Powercharts

• Understanding of Financial Counseling process, including POS (point of service) collections

• Extensive knowledge of Patient Eligibility program qualifications for Social Security, Medicaid, and VOVC

• Strong verbal and written communication skills

What Would Be Nice to Have:

• Knowledge of the financial assistance program

• Knowledge of Medicaid Application process

• Understanding of Medical Records request process

• Knowledge of SSI appeals and reapplication process

• Ability to multitask and meet deadlines