Financial Counselor/Authorization Coordinator, Rehab Services

Under the direction of the Central Scheduling Manager, the Financial Counselor and Authorization Coordinator coordinates prior authorizations for Rehabilitation Services procedures at Duncan Regional Hospital (DRH). Communicates effectively with the patient, provider offices, insurance companies, and various hospital departments to coordinate care and ensure prior authorizations are received prior to procedures. Establishes and maintains successful communication with providers and their office staff to promote positive patient outcomes. Provide patients with a positive financial experience by helping patients navigate and understand insurance benefits and their potential financial liability for services.

RESPONSIBILITIES (ESSENTIAL FUNCTIONS):

• Coordinate with Rehab staff to ensure prior authorizations are obtained in an efficient and timely manner requiring the ability to plan, schedule, and organize numerous tasks that directly impact the patients financial responsibility and DRHs reimbursement.
• Perform Prior Authorization Coordinator tasks including but not limited to: Monitor daily pending pre-authorizations within department standards; Review upcoming schedule to identify patients requiring benefit verification and pre-authorization; Secure prior-authorizations prior to services being performed; Review accuracy and completeness of information requested including all supporting documents; Contact providers offices and/or Rehab for additional information as needed; Confidentially handle and submit medical records to insurance to expedite within required timelines; Confirm delivery of requested items to insurance company; Confirm referrals provide accurate and necessary information; Serve as liaison performing direct contact and problem-solving with providers, nurses, patients, insurance companies, Rehab team members; Advise providers, Rehab team, and CWS Manager of patients found not eligible during benefit; Notify patients, providers, and CWS team members of additional information or actions needed; Communicate prior authorization determinations; Obtain additional clinical information for denials to submit appeals to insurance; Contact insurance to request authorization extensions, obtain additional visits, and urgent/priority prior authorizations; Review insurance denials, notify Rehab team of the reason; Communicate any insurance/prior authorization changes or trends to Rehab team; Identify potential quality of care issues, service, or treatment delays; Request and follow up on retroactive prior authorization for urgent procedures when needed.
• Perform Financial Counselor tasks including but not limited to: Review scheduled appointments to estimate payment amounts according to patient exam type and insurance; Advise patients on their insurance benefits and coverage; Contact and counsel with patients to determine appropriate financial arrangements and requirements with the option for charity care and Medicaid eligibility according to policy and procedure; Calculate bad debt with DRH and adjust required payment accordingly; Indicate amount to collect before services are rendered; Notify Rehab staff of any special collection details; Provide collection note and requirements for Rehab staff in WebPT; Print journal with all needed patient information and collection notes for registration staff; Offer instruction for financial assistance option when needed.
• Perform records management tasks including but not limited to: Document all prior authorization information including communication and contact with patients/insurance/providers, approval dates, billing units, procedure codes, and prior authorization number in patient account within Meditech and Web PT; Scan documentation into the EMR system; Handle confidential patient information and adhere to all HIPAA expectations; Document eligibility and benefit information for each appointment; Provide written and verbal communication regarding any scheduling or payment collection issues, notes, or special instructions for patient accounts; Document any other important communication for Rehab staff and other DRH departments regarding the implementation of new procedures;.
• Contribute to the Central Scheduling team by demonstrating solid time management and collaboration with other team members for best practices in managing and obtaining prior authorizations; Serve as a resource to enhance knowledge of team members including those in provider offices; Communicate timely and accurate information; Attend and participate in departmental meetings; Demonstrate teamwork by approaching relationships in a way that reduces conflict and minimizes problems.
• Regular attendance and punctuality for scheduled shifts.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.
• Must adhere to safety protocols at all times.
• Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations.
• Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values.
• Performs other related duties as assigned.

Minimum Qualifications: Communication skills including fluency in oral and written English. Basic computer skills including the ability to send/receive email, navigate information technology associated with the position, and use Electronic Health Record information tools. Ability to remain flexible to quickly adapt to urgent situations. Ability to adapt procedures, processes, tools, equipment, and techniques to accomplish the requirements of the position.

Education and/or Experience: High school diploma or equivalent required. Excellent customer service and verbal/listening/written communication skills required. Must be organized and have the ability to multi-task. Proven organization and time management skills are crucial. Maintains a level of productivity suitable for the department. Demonstrate and apply knowledge of medical terminology and high proficiency of general medical office procedures including HIPPA regulations. Excellent telephone etiquette and customer service skills. Prior scheduling experience in a medical setting preferred. Previous medical and insurance experience preferred. Knowledge of basic anatomy, medical terminology, and outpatient therapy terms preferred.

Certifications, Licenses, Registrations: For those positions requiring travel, a current valid drivers license and automobile liability insurance must be maintained.

Non Safety-Sensitive Position

As a condition of employment, vaccinations are required per DRH Policy. Medical and Religious Exemptions are available upon request.