FINANCIAL COUNSELOR PIWH Job at Cleveland Clinic – 3.9 in Vero Beach South, FL
Primarily responsible for the collection, resolution and/or financial arrangements of patients requiring services from CCIRH that may not be fully reimbursed by third- party coverage. This includes determination and verification of third-party coverage, appropriate coding of financial and demographic data. Responsible for a financial assessment of the patient’s needs as it relates to CCIRH medical services, calculation of amounts not covered by insurance, screening of the patient’s eligibility for state/federal benefit programs, ascertaining patient’s qualification for charity-care funding, establishing payment contracts with patients and guarantors. Assist patients with applying for state, federal and district programs gathering required documentation at the time of service, during their hospital stay or by visiting them at their home.
SUPERVISORY ACCOUNTABILITY: None
NATURE AND SCOPE:
Interacts with patients, family members, physicians, third-party payors and other departments within CCIRH to case management, medical records, BHC and ancillary departments within CCIRH. Interacts with federal and state agencies (CMS), as well as various managed care/commercial payors to ensure compliance and maximum reimbursement. Interacts with patient’s family members, physicians, third-party payors, other CCIRH departments and the Medicaid eligibility vendor to obtain maximum reimbursement or resolution for all accounts assigned.
Responsible for working in a safe and protective manner at all times, keeping in mind that safety and environmental hazards are the responsibility of all employees for themselves, other staff members and patients.
Performs all duties and job responsibilities in a fashion which coincides with the service management philosophy of the hospital including the demonstration of the basics of service excellence towards patients, visitors, staff, peers, physicians and other departments within the medical center.
Secures financial or insurance information for patients that could not provide this information during the admission/registration process.
Informs patient or guarantors of existing self-pay balances or expected co-insurance and deductibles due and attempts to collect payment prior to the new visit or at the point of service.
Interviews those patients already in-house with the intent of collecting or securing acceptable financial arrangements from patients with no insurance or whose insurance will not cover hospital charges in full.
Establishes reasonable payment plans based upon consistent patient financial services policies and the patient’s ability to pay.
Counsels patients on various local, state and federal agencies which may be available to assist with funding of healthcare (i.e., bank loans, Medicaid, Florida Crime Victims, Indian River Medical Center Charity Care Program, pharmaceutical company replacement, etc.).
Evaluates if guarantor’s financial ability to pay meets the hospital’s charity eligibility guidelines; gathers the required documentation and refers to management for approval and writes off the balance.
Based on assignment will locate patients that have not provided required documentation for various and makes home visits to obtain this information.
Prepares reports of account data, services and amounts provided through approved charity-care applications and HCCB program approved services.
Prepares weekly reports of financial counselor productivity and performance measures. Tracking referrals to DFC and eligibility vendor.
Reviews accounts for accurate registration information, verifying insurance information obtaining necessary benefits and pre-certification. Refers accounts to case management to obtain clinical information for insurance certification.
Maintains confidentiality of all scheduling, registration, admission and financial information.
Performs other duties as assigned.
Knowledge of third-party payor and reimbursement, insurance precertification and insurance verification methodologies.
Knowledge of and previous experience with healthcare and medical information systems.
Strong knowledge of Microsoft Windows and products such as Word and Excel.
Evidence of good communication skills and ability to interact with patients, family members, physicians, and third-party payor.
Must have a clear understanding of all financial assistance programs including regulation and qualification criteria.
Excellent online search abilities and able to locate patient using various websites.
Knowledge and understanding of the Health Insurance Portability and Accountability Act.
Knowledge and understanding of purpose and impact of The Joint Commission on Accreditation of Healthcare Organizations.
High School graduate required; college level course or degree preferred.
At least five (5) years’ experience in a business of medical setting.
Experienced in collection work required. Prior insurance, banking, finance or hospital credit background preferred.
Bilingual (Spanish speaking) candidates preferred.
Based on assignment maybe required to have current Florida driver’s license and be insurable by hospital insurance provider.
CCIRH IS A DRUG AND NICOTINE FREE WORKPLACE
About the Company
Company: Cleveland Clinic – 3.9
Company Location: Vero Beach South, FL