Patient Financial Counselor- PRN

Patient Financial Counselor - PRN

Shenandoah Medical Center

• Advocates for patients and family members and acts as a liaison with insurance companies and other third parties to assist in obtaining insurance and other financial information to secure financial approval for services.
• Confirms payer sources with close attention to coordination of benefits, identifies which contract/plan will provide payment for planned care. Performs detailed financial screening of benefits.
• Determines benefit coverage to ensure that it meets the standards and explains the financial requirements to the patient or responsible party and arranges/collects appropriate payments per financial screening policy.
• Develops accurate point of service collections communication and facilitates the collection of these payments.
• Executes a comprehensive review of all cases meeting criteria, coordinates and performs patient/customer interview to define needs, develops and implements a strategy to enable the patient/customer to meet their financial obligation to Shenandoah Medical Center in a mutually satisfactory manner.
• Maintains current knowledge of rules and regulations of industry and government programs, hospital financial and billing policies and educates patients, families, team members and other staff as necessary.
• Maintains extended knowledge base of payer and billing requirements for federal, state, local and commercial sources.
• Maintains and expands knowledge base of web‑based applications used for determining eligibility.
• Participates in educational programs and in‑service meetings to build upon current knowledge base.
• Acts as an educational resource for patients, families, the community and hospital staff.
• Assists in locating resources and/or assistance programs for which uninsured/underinsured patients may be eligible.
• Informs patients and clinical teams of anticipated gaps and/or lack of insurance coverage.
• Interviews patients and/or family members in person: advises patient with regard to next steps or process for securing financial coverage.
• Assists patients and/or family members in completing applications to applying for resources with external agencies or hospital financial assistance in an accurate and timely manner.
• Continues to serve as a point of contact for patients/families throughout the completion of processes.
• Keeps Manager apprised of exceptions, high grade complaints and issues in a timely manner.
• Develops and maintains complete and accurate confidential patient financial records.
• Documents patient contacts and outcomes in the appropriate database in a thorough and timely manner.
• Follows HIPAA regulations and ensures confidentiality of patients’ medical, personal, financial records, employee records and organizational records.
• Establishes and maintains excellent working relationships with representatives from insurance companies, government entities, Social Services, Utilization Management and Patient Financial Services.
• Performs financial clearance.
• Verifies eligibility and benefits for each patient.
• Obtains prior authorization/pre‑certification as required by payer.
• Creates patient financial estimate as required.
• Presents and completes patient waivers as required.
• Documents all financial clearance notes, authorization numbers, and patient correspondence.
• Scans into the EHR system all necessary financial clearance documents.
• Works with Trac tool as required.
• Communicates effectively.
• Maintains close communication with billing offices and collaborates to resolve any billing and reimbursement issues. Facilitates resolution of patient billing issues.
• Shows patience and maturity when challenged by pressure and time restraints in resolving patient inquiries.
• Serves as a representative of the hospital, displaying courtesy, tact, consideration and discretion in all interactions with patients, coworkers and the general public in accordance with the Corporate Mission, Vision and Principles Statement.
• Performs other duties as assigned.

• Seniority Level: Entry level
• Employment Type:
  
  Part‑time
• Job Function:
  Finance and Sales
• Industry: Hospitals and Health Care
• Location:
  
  Shenandoah, IA