Financial Counselor

$2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS

Optumis a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

• Maintains up-to-date knowledge of specific admission, registration, and pre-registration requirements for all areas.
• Ensures the pre-registration process is complete for all assigned accounts at least 5-days prior to the scheduled date of service whenever possible.
• Verifies insurance eligibility and benefits on all assigned accounts using electronic verification systems or by contacting payers directly to determine level of insurance coverage. When contacting payers directly, utilizes approved scripting.
• Obtains referral, authorization and pre-certification information and documents this information in the ADT system.
• When appropriate, ensures the payer receives a Notice of Admission on all admissions, scheduled and non-scheduled, within 24-hours or the next business day.
• Meets CMS billing requirements for the completion of the MSP, issuance of the Important Message from Medicare, issuance of the Observation Notice, and other applicable requirements, documenting completion within the hospital's information system for regulatory compliance and audit purposes.
• Follows up on missing authorizations. If authorization is not obtained within 48-hours prior to service, contacts the patient to advise them of their financial responsibility.
• Thoroughly and accurately documents insurance verification and authorization information in the ADT system, identifying outstanding deductibles, copayments, coinsurance, and policy limitations, and advises patient and collects amounts due at or before the time of service.
• Identifies any outstanding balance due from previous visits, notifies patient during the financial clearance process and requests patient payment.
• Sets up payment plans for patients who cannot pay their entire current copayment and/or past balance in one payment.
• Explains the Payment and Billing Assistance Program to all patients regardless of financial concerns or limitations.
• Interviews self-pay patients to identify potential eligibility for government aid and/or other payer sources, including Medicaid presumptive eligibility. Follows appropriate policy and/or refers to eligibility vendor.
• Understands and follows the "Delay/Defer" policy and escalates accounts that do not meet financial clearance requirements to Patient Registration leadership immediately.
• For patients who qualify, offers a flat rate discount based on estimated charges, percent of reimbursement, and/or hospital specific policy and procedure.
• Thoroughly and accurately documents the conversation with the patient regarding financial liabilities, agreement to pay and/or payment assistance.
• Clarifies division of financial responsibility if payment for services is split between a medical group and an insurance company. Ensures this information is clearly documented in the ADT system.
• Verifies medical necessity check has been completed for outpatient services. If not completed and only when appropriate, uses technology tools to complete medical necessity checks and/or notifies patients that an ABN will need to be signed.
• Responsible for reviewing assigned accounts to ensure accuracy, and to ensure required documentation is obtained and complete.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• High School Diploma/GED (or higher).
• 2+ years of experience working in a hospital Patient Registration department, physician office setting, healthcare insurance company, revenue cycle vendor, and/or other revenue cycle-related role. (3 years preferred. Applicable education and/or training can be used to balance a lack of experience).
• 1+ years of experience in customer service preferably in a healthcare environment.
• 1+ years of experience with working knowledge of facility pricing structure and cost estimates.

• Thorough understanding of insurance policies and procedures.
• Thorough knowledge of charity care programs as well as various government and non-government payment assistance programs preferred.
• Basic knowledge of ICD-9 (10) and CPT terminology.
• Working knowledge of medical terminology.
• Able to perform basic mathematics for payment calculation.
• Experience in requesting and processing financial…