Financial Counselor, Central Scheduling

Under the direction of the Central Scheduling Manager, provides patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. The Financial Counselor creates estimates, advises patients on their insurance benefits and coverage, and in some cases accesses patient referrals for appropriateness. Ensures patient demographics are accurately updated, allowing for timely and efficient billing. The position requires the ability to plan and schedule and organize numerous tasks that directly impact hospital reimbursement.

RESPONSIBILITIES (ESSENTIAL FUNCTIONS):

• Review next day or next several days schedule to identify patients that will require benefit verification and pre-authorization.
• Call insurance company or use insurance website to verify eligibility and benefits.
• Save all insurance verifications from websites per departmental procedure.
• Obtain reference numbers and contact information when contacting insurance companies.
• Document eligibility and benefit information for each scheduled appointment.
• Call physician/provider offices for patients who are found “not eligible” at time of benefit verification and inform Manager.
• Review scheduled appointments and estimate payment amounts according to patient exam type and insurance plan.
• Calculate “bad debt” with DRH and adjust required payment accordingly.
• Verify if pre-authorization is needed when insurance is contacted or reviewed online.
• Verify that a pre-authorization has been done for the correct procedure and time frame includes scheduled procedure date.
• Assure an order is valid and includes all required information to meet CMS guidelines.
• Obtain new/corrected orders from physician/provider offices when necessary.
• Confirm scheduled procedure matches the physician/provider order.
• Prepare patient paperwork packets according to established departmental policy/needs.
• Provide complete patient packets to department timely and in accordance with departmental policy and procedure.
• Prepare journal for all required patient types according the departmental procedure.
• Complete patient insurance journal accurately.
• Indicate confirmed benefit eligibility and coverage on journal.
• Indicate amount that is to be collected prior to services being rendered.
• Notify registration staff of any special collection details.
• Provide collection note and requirements for registration staff.
• Print journal with all needed patient information and collection notes for registration staff.
• Save journal to patients account in the BAR comments.
• Save journal to CC journal file according to departmental guidelines.
• Provide written and verbal communication with co-workers and departments regarding any scheduling issues, collections, notes or special instructions for patient accounts.
• Document any other important communication for CWS staff and other Duncan Regional departments regarding the implementation of new procedures.
• Work with scheduling and registration staff to process same day MRI or CT add-ons as required regarding benefits and pre-authorization.
• Contact and counsel with patients to determine appropriate financial arrangements and requirements and the option for potential charity care and Medicaid eligibility according to policy and procedure.
• Offer instruction for Financial Assistance op