Financial Clearance CounselorNH-United States-Dover Apply View Saved Jobs Job ID 3156517 Date posted 05/22/2021
At Wentworth-Douglass, we value people who contribute to patient-centered care that enhances community health; we recognize and reward those who share our values and transform our patients' lives. We invite you to explore opportunities, cultivate community wellness and professional growth.
Utilizes organizational, clerical skills and computer applications to acquire and maintain knowledge and competency in Financial Clearance and Revenue Cycle to ensure process efficiency. Demonstrates a high level of professionalism through active participation in team initiatives. Expertly completes all tasks related to order control, insurance verification and pre-certification processes in accordance with organization standards and State / Federal government regulations. Understands and can clearly communicate the Patient Financial Responsibility Agreement and corresponding Policy to both internal and external customers. Org-wide Competencies.
1.Utilizes organizational, clerical skills and computer applications to acquire and maintain knowledge and competency in Financial Clearance and Revenue Cycle to ensure process efficiency.
a.Understands and stays current with knowledge of insurance contracts and payer policies related to financial clearance and authorization.
b.Maintains work area in a professional manner. Troubleshoots department equipment. Notifies department manager or supervisor or IS of unresolved failures.
c.Maintains filling systems according to department standards.
d.Efficiently utilizes and maintains the knowledge pertinent to the various computer applications and systems within the department.
e.Participates in ongoing educational activities related to Financial Clearance.
f.Acquires and maintains knowledge and competency in all areas of Financial Clearance, including but not limited to Order Control, Pre-certification, Pre-Registration, Scheduling, Eligibility Worklists and Financial Assistance.
g.Seeks constructive feedback regarding his or her own work in the revenue cycle. Makes changes base on feedback provided.
2.Demonstrates a high level of professionalism through active participation in team initiatives.
.Requires minimal direct supervision, functions well within the team and fosters the team initiatives.
a.Serves as a department liason in the absence of the Manager/Supervisor/Lead.
b.Plans and performs additional functions within the team assignments and department as directed.
c.Participates in the orientation and education of internal personnel. Assists in the maintenance of all pertinent training materials, sign off sheets and public education resources.
d.Assists in the prep of agendas for team meetings and completing of meeting minutes.
e.Works in conjunction with leadership and peers to maintain staff coverage for planned and unplanned time off.
f.Maintains and utilizes a distribution list for internal and external education relevant to Financial Clearance.
3.Expertly completes all tasks related to order control, insurance verification and pre-certification processes in accordance with organization standards and State / Federal government regulations.
.Validates orders based on RC-09 requirements, along with department protocols. Works in conjunction with Physician Practices and Ancillary Departments to obtain valid orders.
a.Ensures ICD Diagnostic codes and CPT Procedure codes are appropriate for the ordered procedure and meet medical necessity / medical policy, and are accurately used to obtain authorization.
b.Confirms insurance eligibility and coverage of benefits for the ordered procedure(s) and documents insurance status in the system prior to the patient receiving services. Informs appropriate parties of any discrepancies.
c.Verifies that authorizations submitted by outside ordering facilities are approved and are for the correct date of service or coverage dates / facility / ordering provider / procedure / ICD and CPT code(s).
d.Obtains authorizations for required outpatient diagnostics ordered by WDHS Providers in a timely manner and document authorization determination in the appropriate system. Communicates discrepancies with appropriate parties and completes all required follow ups.
e.Deciphers the correct course of action for all orders in the ED Precert folder and take appropriate action. Maintain the folder and all related follow ups.
f.Maintains the Reference Guide for Outpatient Diagnostic Precertification and ensures that it is published in a timely fashion after each update. Conducts reviews of the payer websites to ensure accuracy and documents revisions.
g.Utilizes price estimation software to produce out of pocket estimates for patients.
h.Works in conjunction with leadership to research and/or appeal denials related to authorization. Assist with implementation of necessary workflow changes and education materials in response to denials.
i.Communicates with payers to validate notification requirements for all bedded patients. Obtains notification or authorization accordingly and enters determination into all appropriate systems, including but not limited to Midas Care Management, Soarian Financials and Payers.
4.Understands and can clearly communicate the Patient Financial Responsibility Agreement and corresponding Policy to both internal and external customers.
.Leads financial counseling conversations and offers education to patients about insurance, coverage of benefits, authorization and out of pocket responsibilities. Appropriately documents conversations in system. Completes follow up conversations and action items as needed.
a.Properly utilizes the Patient Financial Responsibility Agreement. Respectfully completes discussion with the patient or representative and documents the form accordingly. Informs department of expected patient decision for service and offers support at the time of patient's check in.
b.Maintains knowledge of and ability to assist with support services that are available to patients, including but not limited to; payment plans, financial assistance and financial planning. Understands and can clearly explain the Financial Assistance Policy and the eligibility criteria.
c.Troubleshoots patient financial responsibility concerns. Reviews occurrences with leadership and documents appropriately. Responds to patient inquiries in a timely manner.
d.Assists with maintenance of the Patient Financial Responsibility Agreement and related policy, and all pertinent forms and education materials.
Experience Minimum Required
• Minimum of 3 years of experience working in a healthcare clerical or insurance related field, or an associate's degree, or active pursuit of a bachelor's degree.
• Demonstrates team concepts, the ability to multitask, lead and communicate effectively.
• Previous experience in the healthcare insurance field, preferably in a hospital setting.
• Experience with financial counseling, reimbursement and collections in a healthcare setting.
Education Minimum Required
• High School Diploma or GED.
• Successful completion of a Medical terminology course.
• Bachelor's Degree in a financial / medical / business field of study
Special Skills Minimum Required
• The ability to multi-task in a fast-paced environment.
• Present in a calm, professional manner.
• Requires the knowledge and ability to utilize various computer and on-line applications.
• Offer exemplary internal and external customer relations.
• Strong relationship building skills and effective communication skills.
• Advanced knowledge of medical terminology, insurance verification and authorization processes as it relates to Revenue Cycle.
· The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)