Medical Financial Coordintor

Description

AWHS Medical Financial Counselor Job Description

Job Summary:

The Medical Financial Counselor position serves as a primary contact to educate families and individual patients about insurance and patient financial responsibilities. The Patient Financial Counselor conducts all interactions in a manner that result in a positive patient experience and full patient understanding of their financial responsibilities and options.

Reports to: Practice Administrator.

FLSA Status: Non-Exempt.

Essential Duties/Responsibilities:

• Promote the mission, vision, and values of the organization
• Greet all patients, families and visitors with a positive, cheerful attitude
• Performs pre-admitting activities, such as communicating with families prior to procedures and admission to obtain all the necessary financial information.
• Verifies the patient’s insurance information prior to procedures and admission and enters the information into the EMR.
• Conducts personal interviews to obtain required demographics and required signatures on legal consents and insurance forms.
• Interviews patients or responsible individuals to explain insurance coverage, deductibles, out of pocket and co-pays, and lifetime maximums.
• Establishes patient liability based on insurance verification information, applicable discounts and estimated cost of planned care.
• Interprets and explains to patients their charges, services and organizational policy regarding payment of bills.
• Collects the initial payment for services as well as tracking payments in accordance with organizational policy regarding payment of bills.
• Ensures financial obligations of patients are met in a timely manner.
• Promotes positive public relations with patients, residents, family members, and guests.
• Receives, answers and resolves incoming calls and emails.
• Maintains established productivity levels for the department / performs other administrative tasks as assigned.
• Records and maintains complete documentation of activities performed on account while in-house
• Calculate and collect cash payments appropriately for all patients
• Advises self-pay patients of their medical care options available in the community for future follow-up care
• Participates in data gathering for financial reporting
• Set up arrangements / monthly installment plans for patients to payoff balances within the guidelines of divisional collection policies. Follow up on any payments that were missed within 3 days.
• Discuss outstanding balances with patients attempting to receive future services. Provide an estimate for the future service and create a payment plan to resolve older debt.
• Makes collection calls on all self-pay and private pay accounts starting at 60 days without payment. All patients will receive a minimum of three calls and a collection warning letter prior to being submitted to a collection agency. The calls and letters are to be made and mailed at 60, 90, and 120 days respectively.
• Create detailed notes in the system to reflect all actions performed on an account.
• Maintain complete records of all patients applying for indigent or financial assistance to include the application, proof of income, the acceptance/denial letter, and any other applicable documentation.
• Submit bad debt collection files on a monthly basis.
• Maintain a relationship with our collection agencies and work together to find the best solution for our patients.

Requirements

Required Knowledge/Skills/Abilities:

• Excellent working knowledge of ICD-9-CM, ICD-10, CPT, and HCPCS, as well as respective reimbursement methodologies associated with each coding system required.
• Knowledge of reimbursement methodologies associated with each coding system.
• Knowledge of third-party insurance and reimbursement procedures regarding plan types: HMO, POS, PPO, Indemnity.
• Knowledge of Medicare Parts A and B insurance and reimbursement procedures.
• Knowledge of office policies and procedures to accurately answer questions from staff, physicians, and patients.
• Knowledge of administrative and clerical procedures and systems such as word processing, Microsoft Office, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
• Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• Knowledge and correct usage of medical terminology.
• Ability to navigate and effectively use EMR. Knowledge and experience with Epic EMR system is preferred.
• Ability to council patients financially regarding outstanding charges & effectively resolve issues at the highest level of customer service.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to maintain confidentiality and professionalism.
• Ability to effectively and clearly communicate in writing, over the telephone, and in person with physicians, office staff, and patients.
• Ability to work as part of a team and promote a positive work environment.
• Ability to listen and understand information and ideas and adjust actions accordingly.
• Ability to comply with all facility policies, procedures and practices.
• Ability to follow directions/instructions from supervisor.
• Ability to read and interpret medical procedures and terminology.
• Ability to exercise independent judgment.
• Ability to maintain professional attire.
• Ability to complete continued education/training requirements.
• Ability to report to work on time and as scheduled.
• Ability to represent the organization in a positive and professional manner at all times.
• Ability to communicate the mission, ethics and goals of the organization.
• Ability to apply feedback, participate in performance improvement, and continuous quality improvement activities.
• Skilled in establishing and maintaining effective working relationships with other employees, patients, and the public.
• Skilled in reviewing health care delivery against established guidelines coupled with knowledge of severity of illnesses/severity of service review criteria.
• Skilled in organization, attention to detail, and task prioritization.
• Skilled in ability to exercise independent judgement and ability to proactively look for ways to help people.
• Skilled in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Skilled in understanding patient needs to provide exceptional customer service.

Education and Experience:

• High school diploma or GED required, Associates degree or higher preferred.
• 2-3 years of demonstrated experience in healthcare financial counseling and/or medical billing.
• 2-3 years of experience with strong knowledge of medical documentation, insurance verifications, third party reimbursement requirements, and financial liability calculations.
• Experience reviewing health care delivery against established guidelines, as well as knowledge of severity of illness/intensity of service review criteria.
• Preferred certification: Certified Patient Account Representative (CPAR).

Physical Requirements:

• Prolonged periods of sitting or standing at a desk and working on a computer in a stationary position. Must be able to remain in a stationary position for a prolonged period of time.
• Constantly operates a computer and other office machinery, such as a calculator, copy machine, computer printer.
• Must be able to lift up to 15 pounds at times and transport up to 15 pounds at a time over short distances.

Equal Opportunity Employer: Atlanta Women’s Healthcare Specialists is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, military or veteran status, gender, color or national origin in its employment practices.

Atlanta Women’s Healthcare Specialists participates in E-Verify to verify the authorization to work within the United States.

We conduct pre-employment drug screening and background checks in accordance with federal and state laws and regulations.