Financial Counselor-Full Time-Days

Cape Fear Valley Health

1d•Onsite

About The Position

The Financial Counselor receives accounts and schedules for review and work-up related to preadmission, admission, add-on procedures, and services. The role interviews patients to obtain and verify accurate demographic and financial information, confirms insurance coverage and benefits, initiates medical certification, reviews medical necessity, and ensures required authorizations and supporting references are on file. The Financial Counselor follows up on encounter denials, informs patients of their financial responsibility, explains insurance coverage, collects payments by phone or at the time of service, and establishes payment arrangements when needed. The position works with patients, responsible parties, insurance companies, physicians, physician offices, case management, utilization review, and hospital departments. It requires accurate documentation in registration and patient accounting systems, adherence to HIPAA guidelines, and flexibility to meet department operating hours and occasional shift or regular-day-off rotations. The role operates in an office or call-center environment.

Requirements

High school graduate or equivalent required.
One year of insurance or clerical experience in a hospital or medical office setting.
Patient Access Specialist certification (CPAS) required within one year of employment.
Proficiency in reading, writing, and speaking English.
Knowledge of insurance and payment collection.
Knowledge of medical terminology.
Knowledge of Microsoft software.
Excellent verbal and written communication, customer service, and problem-solving skills.
Ability to handle complexity and stress amid changing patient, family, visitor, and Health System needs.
May be required to periodically rotate shifts and regular days off; must be flexible to meet department hours of operation.
Ability to communicate orally, see, and hear to collect information.
Dexterity to operate office equipment.
Ability to regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds, and occasionally lift or move up to 50 pounds.

Nice To Haves

Associate degree in Business or Health Care Administration and/or Computer Technology preferred.

Responsibilities

Contact and interview patients, responsible parties, and insurance companies to secure insurance benefits for hospital or ambulatory services.
Verify insurance eligibility and benefits using EDI transactions, web access, and payer calls, and document results and reference numbers in the appropriate registration system.
Determine authorization needs, including pre-certifications, third-party authorizations, and referrals; contact payers, physicians, or case management/utilization review as needed and ensure authorizations match ordered tests.
Pre-register patients for upcoming visits by validating, obtaining, and entering demographic, financial, and insurance information.
Validate medical necessity for Medicare and non-Medicare cases to ensure clinical and financial clearance.
Contact physicians or office staff to clarify diagnoses, tests, or procedures when necessary.
Inform patients or guarantors of financial liabilities and collect copayments, coinsurance, deductibles, deposits, and outstanding balances during preregistration.
Calculate patient liabilities, provide financial education, refer patients to resource counseling when appropriate, document payments and actions, provide receipts, and assist with payment arrangements.
Screen appropriate patients for market insurance.
Obtain signed physician orders for scheduled tests and procedures and scan them into the electronic record.
Follow up on insurance denials and initiate appeals, retro-authorizations, or other actions as needed.
Assist insurers, physicians, physician practices, and hospital departments with patient information in accordance with HIPAA guidelines.
Meet or exceed accuracy standards set by Patient Access Leadership; maintain account integrity by working error reports daily, entering accurate data, and documenting collection attempts and efforts to obtain missing documentation.
Perform other duties as assigned.