Financial Counselor

Texas Children's Hospital•The Woodlands, TX

About The Position

The Financial Counselor works within Admissions and the Emergency Center, with backup support for Patient Services Specialists and Representatives. The role completes insurance verification for assigned new admissions and ensures inpatient and outpatient visits have complete, accurate demographic and financial information. The counselor also works with international payers, financial institutions, and foreign hospitals to secure financial coverage for international patients. When needed, the role may provide overflow or downtime coverage for the Patient Access Representative and perform the responsibilities described for that position.

Requirements

High school diploma or GED.
Two years of related experience.
Ability to work well in a fast-paced setting.

Nice To Haves

Bachelor’s degree with an emphasis in Business.

Responsibilities

Verify insurance, identify primary, secondary, and tertiary payers, and follow inpatient and outpatient accounts throughout treatment.
Notify insurers of admissions within 24 hours in accordance with contracted guidelines; review insurance cards, obtain authorization and eligibility information, confirm coordination of benefits, assign appropriate plan codes, confirm employer eligibility, identify parent or guarantor birth dates, and obtain required clinical and financial authorizations.
Document communications clearly and objectively in real time in Epic patient notes, and scan documents into the documents table when applicable.
Follow contractual guidelines when obtaining initial or continuing service authorizations and coordinate with Care Managers or Social Workers to provide required information; refer issues to the Manager or Director.
Use the Work Queue daily to track accounts on hold and follow up with guarantors within one business day of admission when insurance coverage questions arise, seeking to secure accounts before discharge.
Verify pharmacy benefits for assigned Hematology/Oncology, Cardiology, Neonatology, and other patients to determine whether discharge medication assistance may be needed.
Review transplant patient accounts and coordinate with transplant coordinators to determine whether visits are transplant-related or for disease management; update Epic flags, notes, and plan codes for billing.
Secure scheduled clinic visits before the service date and coordinate care options with physicians or clinic nurses when visits are not financially secured, including determining whether visits should be rescheduled or redirected to another provider.
Provide International Patient Services with estimates for physician and facility charges before visits and obtain, scan, and index Letters of Guarantee or Authorization in Epic.
Meet with families sensitively and promptly to assess financial status and potential assistance with third-party coverage.
Minimize reimbursement losses by securing coverage before discharge for unscheduled admissions or during patient visits, and maximize the efficiency and accuracy of collections for scheduled patients.
Participate in the department’s process improvement program.
Provide required chart documentation, including signed general consent, information release, advance care directives, and other documents required by JCAHO or other regulatory bodies; obtain required signatures.
Provide overflow or downtime coverage for Patient Access Representative responsibilities when needed.