Counselor Jobs

About The Position

Requirements

• High School diploma with 3-5 years of strong customer service experience in healthcare or human services setting.
• Must complete MassHealth’s curriculum for Certified Application Counselor, (CAC) and maintain certification renewal annually.
• Individual must complete training and obtain CAC certification within 45 days of hire date.
• Work experience to include 2-3 years of strong customer service experience, preferably in a healthcare or human services setting.
• Demonstrates professionalism, maturity, and confidence needed to work effectively in a diverse, multi-cultural, and decentralized environment.
• Displays strong, consistent communication skills, (oral and written), interpersonal skill, and record keeping skills.
• Demonstrates knowledge and understanding of eligibility criteria and application process for programs offered through MassHealth, Health Safety Net, ConnectorCare, and BMC’s Charity Care Program.
• Displays strong organizational skills with ability to manage multiple tasks simultaneously; prioritize work assignments appropriately; and complete follow up task timely.
• Demonstrates strong work ethic and ability to meet performance goals for productivity and outcomes with minimal direct supervision.
• Demonstrates critical thinking and sound judgment in addressing and resolving barriers, issues, or concerns identified.
• Requires strong technical computer skills and proficiency in utilizing Epic and external database systems to research cases and successfully assist patients in securing active coverage.
• Displays exceptional customer skills and the ability to engage patients, family members, and team members respectfully, with empathy and cultural sensitivity.

Nice To Haves

• Bachelor's degree strongly preferred.
• Bilingual persons and persons with hospital and/or healthcare experience strongly preferred.

Responsibilities

• Demonstrates respectful personal conduct and utilizes AIDET when engaging patients and visitors.
• Completes MassHealth’s curriculum for Certified Application Counselor and renews certification annually.
• Provides information about the full range of medical and dental insurance programs available through the Health Insurance Exchange (HIX).
• Interviews patients, in a language and manner best understood, to determine eligibility and communicate enrollment options and plan benefits for which patients qualify.
• Answers questions about Qualified Health Plans (QHP) and Qualified Dental Plans (QDP).
• Explains subsidized Qualified Health Plans available through premium tax credits or informs patients of expected out-of-pocket expenses, co-pays, and deductibles when applicable.
• Utilizes protected software programs to determine patient eligibility for MassHealth, Health Safety Net, ConnectorCare, and other insurance carriers and assists with enrollment process.
• Initiates communication with patients, by phone, mail, or email, to initiate new applications or plan renewals for health insurance coverage.
• Informs patients of important deadlines, effective dates for coverage, and required documentation to determine eligibility.
• Scans MassHealth applications and supporting verification documents into HIX and patients’ Epic record.
• Documents in Epic the status of all applications initiated by adding a financial tracker and recording actions taken and follow-up efforts required to complete and submit for processing.
• As requested, assists patients with enrolling in an ACO or changing selection of ACO, to ensure continued access to covered services.
• Provides voter registration information and registration assistance as needed; completes appropriate patient declination form for applicants as requested.
• Validates and updates active insurance coverage in the hospital registration and billing system on accounts with covered dates of service.
• Assists patients with billing questions or concerns.
• For patients deemed ineligible for financial assistance programs, provides information regarding self-pay discount and payment plan options.
• Collects and posts payments for balances related to self-pay, Ad-Hoc, and Flat Fee contracts in accordance with BMC policy and procedure for collection practices.
• Interacts with numerous departments to resolve insurance and billing questions (e.g., Customer Service, Pharmacy, Social Service, Case Management, Patient Accounts, Clinic Staff, Unit Nursing staff, professional billing etc.)
• Provides pricing estimates for elective services, as requested, if patient is uninsured or if services are uncovered by payor.
• Understands and adheres to rules established by the BMC Credit and Collection Policy.
• Assists patients with confidential applications for protected services, adding account notes to notify others of the patient’s protected status.
• Assists patients with medical hardship and confidential applications, obtaining and submitting verification documents and applicable medical bills required to apply and make a determination of eligibility.
• Responds to telephone calls in a courteous manner.
• Responds promptly to all inquiries from staff, patients, and general public.
• As needed, refers callers to other departments or resources deemed appropriate for resolution.
• Presents and interacts respectfully and professionally with BMC patients, visitors, and other team members; works cooperatively and respectfully with other departments and disciplines across the organization.
• Maintains daily written reports of work activity to document patient enrollments and outcomes; patient complaints and resolutions; patient declinations, etc.
• Demonstrates superior customer service standards.
• Participates in regular staff meetings and scheduled trainings to maintain required core competencies.
• Serves as a resource and subject matter expert regarding financial assistance programs.
• Provides education and advisement on health insurance options and enrollment requirements for other hospital departments, community health centers, community leaders and other personnel as needed.
• Under the direction of PFC Manager, assists with the orientation, including shadowing of new staff as assigned.
• Validates and/or updates demographic and income information in HIX portal for “known” patients with prior history of program eligibility.
• Validates patients’ active insurance coverage and updates current plans in Epic.
• Collects and posts payments on accounts with outstanding balances.
• Maintains and closes Epic Cash Drawer and documents transactions in patients’ financial trackers.
• Schedules tasks for Financial Counseling Enrollment Coordinators, (FCECs) to conduct patient follow-up on pending applications to ensure that required documents are obtained and applications are completed and submitted timely to secure retroactive coverage.
• Protects patient and family confidentiality.
• Performs other duties and tasks as assigned.

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• Pharmacy benefits
• Contract increases
• Flexible Spending Accounts
• 403(b) savings matches
• Earned time cash out
• Paid time off
• Career advancement opportunities
• Resources to support employee and family wellbeing