Patient Financial Counselor

Serves as primary resource in assisting and determining financial assistance opportunities for BTNRH patients and families prior to, throughout and following their care delivery. Assists patients, parents and/or guardians in understanding their financial obligations and exploring the situational appropriate financial options, such as providing care estimation, financial assistance, payment plans and enrollment for Government agency healthcare programs. Serves as the expert and primary point person regarding financial assistance for our patients, clinical teams and referral sources.

SCHEDULE: Monday-Friday 8a-5p

MAJOR RESPONSIBILITIES & DUTIES:

• Assists patients and/or guardians in determining an estimate for cost of services to be rendered by conducting a financial screening and anticipates out of pocket liability including: co-payments, coinsurance, deductible, and non-covered or self-pay service charges prior to their visit or rendering of service by utilizing resources which may include but are not limited to; payor websites, employer benefit departments, servicing provider representative, internal electronic medical record and charging source systems.

• Collects estimated out of pocket liabilities in advance of services and/or counsels appropriate party with options available to assist them via enrolling in governmental programs, setting up payment plans, and/or completing the full application process for BTNRH Financial Assistance, depending on current income levels, lifetime max benefit levels, and any catastrophic medical needs or services rendered.

• Assists patients in completing NE Medicaid or independent state agency Medicaid applications and provides aid in ensuring the proper documentation for approval of their application is obtained and submitted to agency officials. Applications may be made through various programs such as MHCP, Emergency Alien Medical Program, and various waiver program applications.

• Refers patients to appropriate SSI office to apply for disability when conditions warrant this type of assistance.

• Maintains summary data to report quarterly, or as needed, to re-cap activities, time, and expenses related to filing financial assistance applications, Medicaid application processing, community resource referrals CHIPS, COBRA benefit reviews, and collection efforts.

• Serves as a liaison between the patient, referral sources (e.g., social work, Registration, Physicians, Hospital, and Ancillary service lines), BTNRH Business Office and clinical operations to explain charges and offer acceptable payment options and/or outside agency resources.

• Performs annual review and updating of policy and procedures relating to financial assistance guidelines and practices.

• Checks all pending Medicaid applications daily. At point of approval, reviews patient level encounters and account information, makes appropriate updates to coverage, alerts pre-certification and/or utilization review nursing team for any patients currently admitted or pending admission status and flags accounts for claims processing. For denied applications, determines cause of denial and determines eligibility for financial assistance or appropriate payment options.

• Performs a monthly check, during the first week of each month, of all in-house NE & IA Medicaid patients, as well as any scheduled surgeries in the current month, previously eligible for the prior month. Making appropriate updates to all affected systems, as well as providing updates to appropriate other parties as needed for billing, authorization and discharge planning purposes.

• Assists the patient with contacting insurance companies when questions arise concerning benefits, coverage, and payment liability for services, either proactively or with dispute of existing charges.

• Performs proactive review of all self-pay accounts scheduled for services to be performed at BTNRH clinics and/or currently admitted to the facility that may involve potentially high dollar services or lengthened stays prior to discharge.

• Acts as liaison between BTNRH and States of IA and NE departments of Health and Human Services to remain informed of policies and guidelines as well as changes and updates. Annually coordinates and attends on-site informational meeting with state representatives to update BTNRH on available programs available to the public, changes in procedures, policies and/or guidelines, and to address any questions/concerns staff may have regarding current policies and procedures.

• Provides timely communication updates to members of leadership, compliance and marketing as needed to ensure compliance and accuracy of marketing materials.

• Annually reviews and updates federal po