Medical Financial Counselor Jobs

About The Position

Requirements

• High school diploma or GED required.
• Two years of related experience required.

Nice To Haves

• Bachelor’s degree with an emphasis in Business preferred.

Responsibilities

• Complete insurance verification for assigned new admissions and follow inpatient and outpatient accounts throughout the course of treatment.
• Determine primary, secondary, and tertiary payers; review insurance cards; obtain benefits, eligibility, and initial authorization; confirm coordination of benefits; and assign appropriate plan codes.
• Notify insurance companies of patient admissions within 24 hours, in accordance with contracted payer guidelines.
• Confirm eligibility with the insured’s employer and identify the birth date of parents or guarantors when needed.
• Obtain clinical and financial authorization required by contract and adhere to payer guidelines for initial and continuing authorization.
• Document communications clearly and objectively in real time in Epic, and scan documents into the appropriate document table when applicable.
• Communicate with Care Managers and Social Workers to facilitate timely authorization information, and refer issues to the Manager or Director for discussion with Care Management.
• Use the Work Queue daily to track accounts on hold by other departments and follow up with guarantors within one business day when insurance coverage issues arise.
• Make every effort to secure accounts before patient discharge and minimize reimbursement loss for inpatient and outpatient visits.
• Verify pharmacy benefits for assigned patients in Hematology/Oncology, Cardiology, Neonatology, and other services to determine whether discharge medication assistance may be needed.
• Review the Work Queue for transplant patients and contact the transplant coordinator to determine whether visits are transplant-related or for disease management.
• Update patient flags, notes, and plan codes in Epic to support appropriate billing.
• Secure scheduled clinic visits before the date of service and coordinate care options with the physician or clinic nurse when financial coverage is not secured.
• Work with providers to determine whether an unsecured visit can be rescheduled or the patient should be redirected to another provider, such as a Primary Care Physician.
• Provide International Patient Services with estimates for physician and facility charges before visits, based on the information provided.
• Obtain Letters of Guarantee or Authorization and ensure they are scanned and indexed in Epic.
• Meet with families sensitively and promptly to assess financial status and potential assistance for third-party coverage.
• Maximize the efficiency and accuracy of collections for scheduled patients.
• Participate in the department’s process improvement program.
• Provide required patient-chart documentation, including signed consent, information release, advanced care directives, and other regulatory documents, and obtain required signatures.
• Provide overflow or downtime coverage for Patient Access Representative duties as needed.