Financial Counseling Representative
Sanford Health
Summary
The Financial Counseling Representative provides financial counseling to assist patients in understanding their financial responsibility to Sanford and to offer appropriate resources and options to meet that responsibility.
Job description
- Answers billing questions.
- Reviews patient's insurance coverage and Explanation of Benefits (EOBs).
- Provides clarification regarding what charges were incurred and why they were incurred.
- Reviews insurance denials and provides an explanation for the denial to the patient.
- Reviews payment plan guidelines and assists in setting up payment arrangements.
- Determines if patient is eligible for payment assistance programs and assists in the application process, if applicable.
- Educates patients regarding insurance concepts, such as what copayments are, what services are covered, effective dates of coverage, when a referral is needed and the effect on insurance, how to obtain a valid referral and resubmit the claim, and how effective dates of coverage influence insurance payments.
- May assist patient in filling out medical assistance program paperwork, as well as referrals to Medicaid or other insurance aid or disability programs.
- Frequently advises uninsured patients on outstanding medical costs associated with procedures performed in a clinic setting and establishes a payment plan.
- Interacts with patients in-person and must be able to empathize with them while also diffusing strong emotions.
- Calculates and provides cost estimates for medical procedures, including the patient's anticipated share.
- Advises on and collects prepayments for services not covered by insurance.
- May perform guest service duties, as needed.
- Other duties as assigned.
Requirements
- Computer skills sufficient to operate on-line systems and complex software with advanced functionality.
- Oral and written communication skills sufficient to interpret and apply policies and procedures for clarification and problem resolution.
- Knowledge of third party payers and basic bookkeeping or accounting principles is required.
- Requires a thorough understanding of insurance products and the ability to accurately read an EOB to determine what adjustments have been made, what payments have been received, and calculate pending balances.
- High school diploma or equivalent preferred.
- Post-secondary education preferred.
- Two years' experience in healthcare service or health insurance preferred.
Company overview
Sanford Health is one of the largest integrated healthcare delivery systems in the United States, operating as a nonprofit organization headquartered in Sioux Falls, South Dakota. Founded in 1894, the organization has grown into a comprehensive health system with 44 medical centers, 482 clinics, and more than 200 senior living facilities across 26 states and nine countries. Sanford Health provides a full spectrum of healthcare services including acute care hospitals, specialty clinics, senior care through the Good Samaritan Society, genomic medicine, global clinics, and the Sanford Health Plan insurance program. The system employs over 48,000 healthcare professionals including 1,400 physicians and delivers care through five Centers of Excellence: Cancer, Children's, Heart, Orthopedics/Sports Medicine, and Women's Health. Annually, Sanford Health handles approximately 5.3 million outpatient visits, 84,000 admissions, and 136,000 surgeries. The organization is also actively involved in medical research and education through partnerships with academic institutions, positioning itself as a regional healthcare leader in the Midwest with expanding international presence.