Financial Counselor E&E RC - North Fulton

Job Summary

This position represents WellStar facilities in financial matters pertaining to communication with patients and insurance companies, appropriately documenting and reporting payment information, educating patients regarding available payment options, financial assistance or other available services. Has a working knowledge of the rules and regulations pertaining to government programs to include appeals and hearing requests. Responsible for updating patient account information during pre-admission, inpatient, and outpatient phases of the patient's visit.

Core Responsibilities and Essential Functions

Financial

• Collects the estimated financial responsibility for current services as well as any outstanding guarantor balances, regardless of patient class at the earliest possible collection control point.
• Monitors in-house accounts and makes financial arrangements with guarantors for payment of their full financial responsibility prior to discharge.
• Communicates with Medicaid Eligibility Vendor to determine eligibility and approval/denial status, as needed. For discharged referrals, contact by phone or letter within 10 days of referral.
• Completes financial evaluation forms to document guarantors' income, expenses, assets and liabilities.
• Identifies those patients without adequate insurance coverage. Makes personal contact with guarantor to determine guarantor's ability to pay non-covered charges, as well as to determine potential eligibility for financial assistance programs (i.e. Medicaid).
• Maintains a list of health care financial assistance programs and the eligibility requirements for each program. Refers patients/guarantors to sources of outside funding assistance, distributes financial assistance (i.e. Medicaid) applications as needed.
• Works efficiently and accurately within designated time frames to ensure a continuity of information and cash flow.
• Interviews guarantors at time of registration, or at least within 24 hours of admission, to verify complete insurance and financial information. Explain financial options, and collect the estimated financial responsibility.
• Documents concise and understandable notes regarding all collection activity, as well as each patient or guarantor interaction. Documents all efforts to collect guarantor account balances, other self-pay collection activities and referrals to Medicaid.
• Coordinates financial counseling activities with Admitting, Outpatient Registration, Emergency Registration, Utilization Review, Nursing, Social Services, and Patient Financial Services.
• Verifies insurance coverage and benefits.
• Consistently meets or exceeds department productivity standards. Formally reports results of collection activity to direct supervisor, daily or according to policy. Provides feedback to PAS management concerning collection and data integrity issues.
• Responsible for completion of appropriate errors and issues in Workqueues.

Quality/Safety

• Reviews daily census and/or applicable workqueues and visits hospital patients when appropriate, verifies patient coverage, benefits, and collects estimated patient liable amounts.
• Interviews each patient or representatives to obtain complete and accurate demographic, financial and insurance information.
• Obtains all necessary signatures and is knowledgeable regarding any special forms that may be required by the patients third-party payer.
• View charges to determine financial estimates and collects appropriate co-pays and/or deductibles.
• Makes corrections and updates patient account information in computer.
• Documents thorough explanatory notes on patient accounts, concerning any non-routine circumstances, clarifying special billing processes.
• Maintains a working knowledge of available information system capabilities and performs all system applications that are required.
• Understands and applies WHS philosophy and objectives, and WellStar and any departmental policies and procedures, as related to assigned duties. Understands the admission, outpatient and emergency registration process.
• Maintains confidentiality of patient information, in accordance with WHS policy and HIPPA regulations.
• Consistently demonstrates the ability to organize work.
• Recognizes and establishes appropriate work priorities and completes work in a productive manner.
• Maintains proficiency in data entry skills.
• Assists with Medicaid screening on all accounts.
• Resolves errors in assigned Workqueues.

Customer Service

• Greets all guest with a positive and professional attitude.
• Answers incoming phone calls and follows through with requests made.
• Maintains courteous and cooperative working relationships with WHS management, patients, physicians, other professional contacts, and the public. Demonstrates ability to tactfully handle difficult situations.
• Presents a well-groomed and professional image in coordination with dept/hospital dress codes.
• Uses appropriate telephone etiquette and scripting.
• Is flexible with work hours to meet department needs.
• Meets service recovery and customer service guidelines.
• Stays current and conveys knowledge of various insurance plans to customers as needed.
• Works well with Team Members and understands appropriate department process.
• Identifies and requests additional information as needed to complete authorization requests.

General

• Adheres to scheduled work hours and provides proper notice of absences, tardies and any other work schedule changes.
• Cross-trains in all areas of registration.
• Attends departmental meetings at the request of WellStar Management.
• Completes all required and/or mandatory training.
• Maintains multiple login credentials to utilize various tools to access third-party and insurance web portals for insurance verification and precertification processes.
• Performs other duties as assigned.