Financial Counselor - CAPROCK EMERGENCY, LLC

Job Summary:

The Financial Counselor is responsible for providing patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. The Financial Counselor is the patient’s point of contact for financial assistance questions. The Financial Counselor collects payments, sets up payment arrangements as appropriate, creates estimates, advises patients in person and over the phone on their insurance benefits and coverage, and in some cases, assesses patient referrals for appropriateness for outpatient testing/procedures. He/She assists with pre-authorization for inpatient admissions. He/She assists patients with eligibility for government programs, CapRock Health’s financial assistance program, and other options for managing high medical liabilities, as needed.

Reporting Structure:  Reports to Director of Business Services, who holds the employee responsible for the achievement of desired goals and objectives.

Education Qualifications and Credentials:

• High School Graduate or GED equivalent, must be able to produce copy of diploma or official transcript
• 3 years of healthcare experience or education equivalency required
• Demonstrated experience in credit, collection and billing is required in a healthcare field, preferably in a hospital setting
• Prior work experience operating a personal computer, in house computer system and other office equipment in required
• Ability to interpret billing manuals, insurance and/or other third-party coverage
• Understanding of the third-party review process
• Understanding of payer funding and authorization procedures to ensure payment
• Understanding of government/state payers, including eligibility factors 
• Knowledge of medical and insurance terminology is required 

Essential Job Functions:

The employee must be able to perform each essential function effectively to be successful in this position.

• Serves as the point of contact for financial assistance related questions; communicating with patients/responsible parties to identify and understand financial, social, and medical histories and other relevant patient information. Explains CapRock Health’s payment policy to patients/responsible party.
• Assesses the current financial situation of patients through the verification of patient insurance benefits; serving as the technical expert in confirming patients benefit coverage and hospital reimbursement.
• Determines the patient’s financial ability to pay and explains insurance coverage and benefits to the patient.
• Counsels patients/responsible parties on out-of-pocket liabilities. Collects deductibles, pre-payments (on elective procedures), and outstanding balances following established collection procedures; or alternatively, creates a payment plan with the patient and documents the agreement appropriately.
• Serves as support to patients and their family members to assure customers have access to all available funding, this involves, working with private as well as governmental agencies, i.e., private insurance, HMO/PPO’s, Medicare, and Worker’s Compensation
• Initiates the financial screening process as appropriate to evaluate eligibility for assistance programs. If financial assistance is needed, gathers all relevant information required to process financial assistance requests; Assisting the patient/responsible party in completing financial statements and gathering supporting financial documentation.
• Assists with contacting physician office and patient to ensure pre-authorization and referral requirements are met prior to the date of service for outpatient services.
• If unable to establish acceptable payment arrangements for elective procedures, informs provider and patient that elective services will be rescheduled or cancelled.
• Communicates financial coverage status and applicable financial decisions with all appropriate parties.
• Assists with contacting physician offices and patients to ensure pre-authorization and referral requirements are met prior to the date of service.
• Assures proper financial classification, determines proper guarantor and updates system accordingly
• Reviews and interprets explanation of benefits received from payers to assist patients and guarantors with understanding of claims processing or denial of services by payer.
• Facilitates, in coordination with Billing, resolution in disputed billing issues which requires intense interaction with patients.

• Records accurate patient demographic information when reviewing previous accounts and accounts with future dates of service.
• Provides estimates of elective procedures and services, calculates payment requirements, and negotiates pre-service payments according to financial clearance requirements.
• Always handles all patient/family contact in a courteous, professional manner
• Consistently interacts with sensitivity to patients/their families and is responsive to individual needs
• Receives and places telephone calls in a skillful manner using appropriate etiquette
• Promotes safety initiatives and follows safety requirements and environment of care by adhering to safety policies, regulatory standards, and infection control policies/guidelines. 
• Attends 80% of unit meetings remaining abreast of current departmental, facility, and organizational goals. Assists in dissemination of information as needed to other team members.
• Participates in staff assessment and performance evaluations as requested. Fosters a positive environment conducive to staff development. Cultivates team members by assisting with competency and training as well as promoting ongoing staff education.
• Diligently executes other duties as assigned.

6.      Abides by company policies and procedures and complies with all applicable State, Federal and local laws, requirements of all Federal and State regulatory agencies and requirements of any applicable accreditation agencies.

Knowledge, Abilities and Skills:

• Requires good listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette.
• Ability to maintain a professional demeanor in a highly stressful and emotional environment, to include crime, behavioral health and suffering patients in addition to life-or-death situations.
• Must be able to exhibit a high level of empathy with the ability to effectively communicate with patients and family members during traumatic events, while demonstrating exceptional customer service skills.
• Demonstrates ability to manage multiple, changing priorities in an effective and organized manner.
• Excellent data entry, numeric, typing and computer navigational skills.
• Basic computer skills and Microsoft Office and Excel.

• Independent judgment and decision making is required to address the full range of tasks and responsibilities. The position requires the ability to plan, schedule and organize numerous tasks that directly impact hospital and physician reimbursement.
• Obtain/Maintain a knowledge of current federal and state laws and regulations (including HIPAA, EMTALA, and others that apply to healthcare billing/collections)

• Is self-motivated and able to problem solve and follow through to achieve outcomes. 
• Demonstrates the ability to effectively communicate with all staff at various levels in the organization.
• Work with a high degree of accuracy and attention to detail
• Can adapt to changing environments, be innovative, and dependable.

Some minimal travel may be required between sites of operations.

Physical Demands:

The physical demands below are typical of those that must be met by the employee to successfully perform the essential functions of the position. Reasonable accommodations may be available for individuals with disabilities.

• Employee is regularly required to hear and speak; is frequently required to sit, stand, walk, use hands to finger, reach with hands and arms, lift and move more than 10 lbs.;
• Employee is occasionally required to lift and move objects up to 25 lbs., climb, balance, stoop, kneel, crouch or crawl. 
• Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. Required to constantly make decisions and concentrate.
• Ability to work with and around potentially hazardous materials and disease