Financial Counselor

Jefferson Health Plans•Philadelphia, PA

7d•Onsite

About The Position

The Financial Counselor/MA Specialist interviews in-house patients referred for Medical Assistance applications. Obtains various paperwork from patients and other hospital departments that are necessary to secure applications according to MA regulations. Work with County Assistance office and referral agencies to obtain Medical Assistance approvals. Process and perform system maintenance pertaining to PA 162 forms. Work with Case Management to insure MA 87s are processed according to MA regulations. Provide support for MA biller. The primary function of this role is to understand the importance Einstein Healthcare Network places on providing exemplary customer service and perform job functions in a manner that helps meet the department customer service goals. This includes identifying customer service issues and resolving or initiating necessary follow-up. The role efficiently and accurately gathers and inputs patient/guarantor demographic and financial information, explains necessary forms, and obtains signatures. It also involves utilizing appropriate reports to contact insurance payers, verifying benefits and obtaining necessary authorizations, and documenting this information in the registration system. The Financial Counselor will work with payors to resolve accounts that are pending or denied, screen patients for assistance programs, and explain insurance benefits while collecting co-pays, deductibles, and self-pay portions or establishing payment arrangements. Maintaining a working knowledge of third-party reimbursement requirements, regulations, registration and scheduling systems, electronic verification tools, and web-based resources is crucial. The role follows Patient Financial Services self-pay policies, including fee schedules, Medical Assistance and Charity Care applications, payment options, and collections. Cash handling and cashiering functions are also part of the responsibilities. The position requires an understanding of the medical necessity screening process, appropriate systems, and ICD-10 and CPT codes. Pre-registration functions, including contacting physician offices, insurance payers, and patients/guarantors, are also performed. The Financial Counselor is cross-trained to staff multiple areas within the department, including Diagnostic/Interventional, Admissions, Cashier, Pre-Registration, Scheduling, and the Emergency Department. They participate in training new team members and work closely with various hospital departments and external entities. Maintaining departmental logs, working assigned reports, and consistently meeting Quality Assurance standards, departmental goals for collections, productivity, and customer service are key. Participation in internal department committees and assisting management in planning and organizing department activities are also expected.

Requirements

High School diploma or equivalent
Two (2) years’ experience in a financial, business office, or customer service environment required.
One year hospital business office experience required
Demonstrated computer skills (including Microsoft Word and Excel).
Working Knowledge of ICD9 coding and medical terminology.
Able to work with minimal supervision.
Well organized, self motivated individual with a positive attitude.
Excellent customer service skills.
Ability to work effectively with all payor and hospital personnel

Responsibilities

Identifies customer service issues and resolves or initiates necessary follow-up.
Efficiently and accurately gathers and inputs patient/guarantor demographic and financial information.
Explains necessary forms and obtains signatures from patient/guarantor.
Utilizes appropriate reports to contact insurance payers, verifying benefits and obtaining necessary authorizations.
Documents authorization and benefit information in registration system.
Works with payors to resolve accounts that are pending or denied.
Screens patient/guarantor for federal, state, county or other assistance programs and completes necessary forms and applications per facility guidelines.
Explains insurance benefits and collects current and outstanding co-pays, deductibles and self-pay portions due or establishes payment arrangements for these balances as appropriate.
Maintains a working knowledge of third-party reimbursement requirements and regulations.
Exhibits working knowledge in the use of all registration and scheduling systems, electronic verification tools and Web based resources.
Follows Patient Financial Services self-pay policies including self-pay fee schedules, completion of Medical Assistance and Charity Care Application, explanation of payment options and collections of monies due.
Follows Patient Financial Services policies related to cash handling and performs department cashiering functions and point of service transactions.
Maintains understanding of the medical necessity screening process and appropriate systems and a working knowledge of ICD-10 and CPT codes.
Performs appropriate pre-registration functions including calling physician offices, insurance payers and the patient/guarantor, as necessary.
Cross-trained with appropriate knowledge and skills necessary to staff multiple areas within department, including but not limited to Diagnostic/Interventional, Admissions, Cashier, Pre-Registration, Scheduling and Emergency Department.
Participates in training of new team members.
Works closely with Nursing, Ancillary, Scheduling, Case Management, Social Workers, Managed Care Companies, Physicians, Administration and Patient Accounting.
Maintains departmental logs for statistical reporting.
Works departmental reports as assigned.
Consistently meets Quality Assurance standards set by Patient Financial Services department.
Meets departmental goals regarding collections, productivity and customer service.
Participates in internal department committees.
Assists his/her manager in planning and organizing department activities.
Interviews in-house patients referred for Medical Assistance applications.
Obtains various paperwork from patients and other hospital departments that are necessary to secure applications according to MA regulations.
Works with County Assistance office and referral agencies to obtain Medical Assistance approvals.
Processes and performs system maintenance pertaining to PA 162 forms.
Works with Case Management to insure MA 87s are processed according to MA regulations.
Provides support for MA biller.

Benefits

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service