Job Description

Financial Counselor, 40 Hrs/Week, Evening Shift (2PM to 10:30PM), Every 3rd Weekend, Holidays Required

I. Position Function:

The primary focus of the Financial Counselor is screening assigned self-pay pre-admits (Inpatient and Out), Inpatient Emergent and Urgent Admissions and meeting with Emergency Room patients after treatment for insurance information not obtained at the time of registration, making self-pay payment arrangements with patients who have the ability to pay prior to, during or after their service, screening and assisting patients with the Mass Health/Low Income/Commonwealth Care application process (entering the information into the Virtual Gateway online application) and the Medicare Indigent Free Care application process(includes visiting patients in their rooms).

The counselor refers inpatient self pay and Medicare with no secondary coverage admissions to our vendor, Peter Kent, to interview patients and assist the patient with the MH/LI/CC application process. If our vendor is not available, the Financial Counselor visits the patient in their room to start the application process. The counselor also refers inpatient psych admissions to our vendor, Health Care Financial Associates, to interview and assist patients with the application process.

The counselor is responsible for interviewing all potential elective self-pay Inpatient SECAP patients for payment arrangements and/or Mass Health/Low Income/Commonwealth Care eligibility once SECAP has determined the clinical appropriateness of the admission (this is a face to face interview).

The Financial Counselor is responsible for the pre-certification and insurance verification processes at the time they obtain any insurance billing information. Insurance information obtained during the pre-admit review or during the admission must be communicated to the Care Management and Patient Access Departments as soon as it has been verified.

The Financial Counselor responds to incoming telephone calls and walk-in patient visits to discuss bills and assists any person who wants to apply for MH/LI/CC assistance. The coordinator follows up on all pending applications to ensure that all documents needed for the application process are obtained and either faxed to the local Mass Health Enrollment Center or mailed to the Central Processing Unit.

The counselor also assists clients with insurance billing issues as necessary.

Performs any duties requested by the Supervisor of Financial Coordination, the Credit & Collection Manager and/or the Regional Director of Patient Financial Services.

II. Job Relationships:

By job category:

- Patient Access Staff

- Care Management Staff

- Multi-Lingual Advocates/Interpreters

- Medical/Surgical Social Worker

- Psychiatry Social Worker

- Physicians and Staff

- Nursing Unit Secretaries

- Patient Service Office Staff

- Free Care Coordinator

- Peter Kent Staff

- HFI Staff

- Cashiering Staff

- Billing Staff

- Medical Record Staff

- Patients and/or Families

- Insurance Carriers/Employers

- Attorneys

III. Authority:

The Financial Counselor is authorized to:

- Interview patients in their hospital room for personal/financial information.

- Request and accept payments.

- Process Mass Health/Low Income/Commonwealth Care and Medicare Indigent applications

IV. A. Responsibilities/Essential Functions:

1.) "Provides superior customer service to internal and external clients, customers,

and patients as referenced in the Service Excellence Standards."

Screen self-pay patients for potential Insurance information not obtained at the time of registration.

Perform pre-certification, insurance verification functions for identified insurance Verify through Internet (Web based payor solutions, Point of Service Devices, telephone calls to Patients, Employers, Schools). Update accounts with demographic and financial information for billing purposes.

Notify Care Management and Patient Access Departments of all changes.

Screen self-pay patients for ability to pay, advise patients regarding methods of payments

Accepted (this includes setting up payment plans), request and collect deposits prior to the date of service, at the time of service or during the patient's hospital stay.

Screen self-pay patients for potential Mass Health/Low Income/Commonwealth Care assistance and assist with the application process, which includes completing and submitting the online Virtual Gateway application and follow up with the patient for additional information and follow up with Mass Health to obtain eligibility. (Note: Most inpatient accounts are now outsourced to a firm to handle the interview and application processes). The Financial Counselor is responsible for covering for the outsource employee and working accounts assigned by Management.

Interview SECAP patients for ability to pay prior to their admission, request/collect payment before admission if they have the ability to pay, complete Mass Health/Low Income application if they are indigent. Notify Unit Secretary when the financial arrangements have been completed. (Note: Difficult interviews because candidates are often under the influence of alcohol or drugs).

Meet with Emergency Room patients, after service in the ER, for insurance information not obtained by the registrar and assist the patient with the Mass Health/Low Income application process, which includes completing and submitting the online Virtual Gateway application and follow up as necessary.

Responsible for requesting self pay payments in the ER, after the patient has received service, whenever the patient has the means to make a payment.

Responsible for requesting and collecting deductibles and co-pays on pre-admits whenever a self pay pre-admit or in-house account is found to have insurance.

Responsible for obtaining Motor Vehicle Insurance Information and filing Liens whenever necessary to protect the interest of the medical center.

The Counselor responds to all incoming telephone calls and patient walk-in visits which are related to a hospital account. The Counselor is responsible for assisting the client to ensure a positive outcome for the patient and the medical center.

The Financial Counselors see clients in the ER and the St. Margaret's Lobby office. Employees are often floated between the locations.

Collaborates with the Free Care Coordinators to ensure that we have all the information/documents necessary to process a Medicare Indigent application.

Updates account with third party billing information as necessary.

Works with Multi-Lingual Advocates as a referral source and for interpretive services.

Maintain current knowledge of insurance carrier coverage and exclusions which might impact patients.

Operate standard office equipment including: Calculator, POS Device, Medicare/Blue Cross Terminals, FAX Machine, Copy Machine and Scan Station.

Assist with training of new employees.

Perform any duties requested by Supervisor or Credit & Collection Manager.

B. Responsibilities/Non-Essential Functions:

Scanning/Photocopying

V. Reporting Requirements:

Reports to the Supervisor of Financial Coordination.

Reports problem accounts to the Supervisor timely.

Reports major events or serious matters related to the office to the Supervisor.

VI. Accountability:

Shall be accountable for maintaining the confidentiality and security of all clinical and financial patient related data and information.

Shall be accountable for abiding by all relevant SEMC and Financial Coordination Unit policies and procedures.

Shall be accountable for insurance verification functions as insurance is identified.

Shall be accountable for resolution of all assigned accounts.

VII. Qualifications:

Minimum Education:

High School Diploma

Minimum Experience:

Two years in related field.

Minimum skills/abilities:

Good interpersonal skills are necessary in order to interact with patients/families/insurance carriers.

Requirements:

- Ability to read and comprehend.

- Ability to effectively communicate both verbally and in writing.

- Ability to perform basic arithmetic calculations using a calculator.

- Ability to use a Personal Computer with Windows applications.

Application Instructions

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