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Employment Type:

Full time

Shift:

Description:

The Financial Counselor is responsible for meeting with patients/guarantors, who require assistance in seeking and applying for healthcare funding (e.g., Charity Care, Medicaid, or other local/governmental funding program) and/or require assistance in reviewing and establishing payment options. The Financial Counselor is responsible for a broad spectrum of duties, beginning with the initial patient contact, via the pre-admit/pre-registration functions and ending with the control and maintenance of the patient’s account until discharge. Within this range, the Financial Counselor is responsible for determining the financial status of the patient during the financial counseling process. May also perform cashier and customer service functions.

SCOPE OF SERVICE/CUSTOMER:

The Financial Counselor is responsible for meeting with patients/guarantors, who require assistance in seeking and applying for healthcare funding (e.g., Charity Care, Medicaid, or other local/governmental funding program) and/or require assistance in reviewing and establishing payment options. The Financial Counselor is responsible for a broad spectrum of duties, beginning with the initial patient contact, via the pre-admit/pre-registration functions and ending with the control and maintenance of the patient’s account until discharge. Within this range, the Financial Counselor is responsible for determining the financial status of the patient during the financial counseling process. May also perform cashier and customer service functions.

ESSENTIAL FUNCTIONS:

Knows, understands, incorporates, and demonstrates the Mercy Medical Center Mission, Vision, and Values in behaviors, practices, and decisions.

Performs activities that relate to financial counseling for multiple patient types (Inpatient Admissions, Outpatient Observation and Bedded Outpatients, Diagnostic Outpatients, Ambulatory Surgery, Emergency Department Registrations, Series accounts, etc.), dissemination of patient information, and support coverage of other departmental divisions. Frequent communications will occur with patients/family members/guarantors, 3rd party payers, local/governmental agencies, attorneys, employers, physicians/office staff and contracted vendors/agencies in the deployment of key activities. Internal contacts include the Pre-Service unit, Patient Access, Social Work Services, Utilization Review/ Case Management, Ancillary and Nursing department staffs. Assists patients in completion of Medicaid and/or charity applications.

Monitors reservation and scheduling information to initiate the financial counseling process on a pre-service, time-of-service and post-service basis. May interview patient and/or their representative either by telephone or in-house to accurately update demographic, clinical, financial and insurance data necessary to complete the financial counseling process. Activities may occur in multiple locations, including patient access points of service, ancillary departments, patient nursing units, Emergency Department, as well as via telephone. Reviews prior account notes for any information that might aid in the application/payment process, as well as documents all encounters and actions. Ensures that all accounts are properly classified in the patient accounting system:

+ All Self-Pay (uninsured) accounts will be screened within 24 hours of service with focus on high dollar accounts (Inpatient Admissions, Outpatient Observation, Bedded Outpatients, Ambulatory Surgery and designated Diagnostic Outpatients);

+ High dollar patient liabilities, including outstanding balances; and

+ Under-insured accounts (e.g., out-of-coverage, exhausted benefits, etc.) will be screened upon identification or upon patient/guarantor request.

Informs patient/guarantor of their liabilities and collects appropriate patient liabilities, including co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration. May calculate patient liabilities, conduct credit scoring and propensity to pay modeling in order to determine the patient/guarantor’s ability and propensity to pay for services. Provides financial education and outline potential funding options, as appropriate. In the collection of funds, the incumbent documents payments/actions in the patient accounting system and provides the patient with a payment receipt.

5. Seeks appropriate funding based upon patient requirements, collecting supporting documentation (payroll stubs, tax returns, credit history, etc.), as required. Provides information and education to the patient, family member and/or guarantor of the application/documentation process. In so doing, the incumbent will encourage patient participation in the funding process and will assist the patient in forwarding the required documentation and application to the appropriate funding agency:

+ Counsels patient/guarantor on patient’s financial liability, third party payer requirements and outside financial resources, including private organizations and foundations, eligibility vendor(s), Medicaid, Medicare, Champus, and/or federal disability programs, etc.;

+ Counsels patient/guarantor of payment plan options and establishes appropriate plan;

+ Investigates No Fault and Workers’ Compensation cases, retrieving police report and insurance information, as required;

+ Assists patient/guarantor in completing a charity application, financial statement and/or payment contract when required according to hospital policies. Analyzes such applications along with income/resident documentation in order to advise the patient of available options. Initiates requests for charity write-off, when appropriate;

+ Analyzes financial and eligibility data, and length of disability to determine potential eligibility for federal, state, and/or county programs, completing the necessary documents within the time limits specified by the appropriate government agency;

+ Determines and manages proper course of action for optimal reimbursement of healthcare charges (e.g., spend down eligibility, out-of-network, Cobra coverage, etc.); and

+ Informs patient/guarantor of flat-rate and discount programs and assists patient in application process, ensuring that adjustments are requested and completed,

+ Responsible for monitoring accounts in the eligibility pending financial class. Refers accounts to the Disputed Claims Management unit or to outside agencies, as appropriate.

Follows-up on eligibility applications status and provides appeal assistance, as appropriate. Follows-up on the collection of payments from settlements, payment arrangements, out-of-network settlements, and specialty services (e.g., cosmetic, worker’s compensation, auto accident, etc.) and determines course of action for non-cooperative patients (e.g., collections placement).

Works with contracted vendors/agencies to qualify applicants, reviewing each case prior to agency placement. Obtains and distributes accounts for litigation, credit consolidation, tax purposes, bad debt recovery, etc. In cooperation with the Manager, may participate in monthly meetings with the contracted vendors/agencies to discuss policies, procedures and pending issues. May maintain statistics of vendors/agencies’ outcomes (number of referrals, number of no shows/cancellations, number of denials, number of pended accounts, number of qualified applicants, etc.). May write-off accounts based upon Mercy Medical Center guidelines.

Provides pricing estimates and communicates pre-service patient liability based on expected charges and potential coverage, as requested.

May serve as a notary public, notarizing documents for patients, physicians and Ministry Organization personnel.

May serve as a liaison for various departments, including but not limited to:

+ Social Work Services in establishing Medicaid pending cases for placement in long-term care facilities or home healthcare; and

+ Utilization Review/Case Management in documenting clinical information and soliciting assistance in clinical documentation from members of the medical staff; in obtaining funding for additional services required after discharge (durable medical equipment, home health, nursing services, etc.); as well as establishing ongoing continuity of care counseling (provision of medical care options), and in discussing potential options for postponing or rescheduling care delivery until funding is obtained.

May prepare special reports as directed by the Manager to document utilization of the Financial Counseling unit's services and patient flow (e.g., patient service time, service volumes, application turnaround time, etc.).

May serve as relief support, if the work schedule or work-load demands assistance to departmental personnel. May also be chosen to serve as a resource to train new employees. Cross-training in various functions is expected to assist in the smooth delivery of departmental services. May provide operational oversight to the Financial Counselor(s) I, as assigned. Relief functions include, but are not limited to:

+ Patient Accounting Customer Service - Acts as an onsite resource for any patient inquiry, complaint or issue regarding patient billing and collections, either responding directly or referring the problem to an appropriate resource for resolution; Cashiering – Acts as back-up for payment receipt and posting; balancing and recording of bank deposits and balancing of cash drawer; performs cash refunding, adjustments and transfers; and other duties to prepare patient accounts for billing prior to and following discharge in order to maximize payment from all sources, to prevent collection issues and to control bad debt; and

+ Registration and Pre-Service – Acts as back-up for registration/check-in and financial clearance activities.

Other duties as needed and assigned by the Manager.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

SKILLS AND ABILITIES REQUIRED:

Excellent communication (verbal and writing) and organizational abilities. Excellent interpersonal skills are necessary in dealing with peers, internal and external customers. Must develop positive relationships with clinical staff to maximize the benefit and effectiveness of the financial counseling function (e.g., Nursing notifies Financial Counselor of when an elusive family member is visiting patient). Accuracy, attentiveness to detail and time management skills are required.

To successfully accomplish the essential job functions of this position, the incumbent will be required to work independently, read, write, and operate keyboard and telephone effectively.

Must be comfortable operating in a collaborative, shared leadership environment.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Mercy Medical Center. Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in an environment that may be stressful with individuals having diverse personalities and work styles. Excellent problem solving skills are essential.

The position requires the ability to comprehend and retain information that can be applied to work procedures to achieve appropriate service delivery.

The greatest challenge in this position is to ensure that financial counseling, customer service and cashiering information is entered promptly and in an accurate manner to assist in the patient flow and to reduce potential financial loss to the patient and the Ministry Organization. The incumbent must have a thorough knowledge of various insurance documentation requirements, funding options, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account, from information obtained from the patient/family.

Completion of regulatory/mandatory certifications and skills validation competencies preferred.

Must possess the ability to comply with Mercy Medical Center policies and procedures.

WORKING CONDITIONS AND PHYSICAL DEMANDS:

Position operates in an office environment. Work area is well-lit, temperature controlled and free from hazards. Occupational exposure to blood or other potentially infectious materials may reasonably be anticipated from the performance of the employee's duties. Skin, eye, mucous membrane, and/or parenteral contact with blood or potentially infectious material is reasonably anticipated. The incumbent is subject to eye-strain due to the many hours spent looking at a CRT screen. The noise level is moderate to high. Work is performed in a contained area.

In a normal workday, employee may sit 6 hours and/or walk 2 hours.

No extreme working conditions or physical demands.

Schedule must be flexible.

Job requires occasional (6%-10%) lifting and carrying up to 40 lbs.

Must be able to see at a near visual acuity level.

Must be able to speak and hear speech.

MINIMUM EDUCATION, LICENSURE, CERTIFICATION, AND EXPERIENCE REQUIRED:

High school diploma or an equivalent combination of education and experience required. Associate degree preferred.

Must possess data entry skills (50-60 keystrokes per minute).

Past work experience of at least two (2) years within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities is required.

Knowledge of insurance and governmental programs, regulations and application processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required.

Working knowledge of medical terminology and basic computer skills are high desirable.

Certified Healthcare Access Associate (CHAA) credentials by the National Association of Healthcare Access Management (NAHAM) is also preferred.

Maintains notary public credentials.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran