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Shenandoah Medical Center · 22 hours ago

Patient Financial Counselor

Shenandoah, Iowa, United States

Full-time

Onsite

New Grad, Entry Level

Shenandoah Medical Center is seeking a Patient Financial Counselor to assist patients in meeting their financial obligations. The role involves reviewing cases, advocating for patients with insurance companies, and maintaining accurate financial records while ensuring compliance with regulations.

Health CareHospitalNon ProfitPrimary and Urgent CareRehabilitation

Responsibilities

Executes a comprehensive review of all cases meeting criteria, coordinates and performs patient/customer interview to define needs, develops and implements a strategy to enable the patient/customer to meet their financial obligation to Shenandoah Medical Center in a mutually satisfactory manner

Advocates for patients and family members and acts as a liaison with insurance companies and other third parties to assist in obtaining insurance and other financial information to secure financial approval for services

Confirms payer sources with close attention to coordination of benefits, identifies which contract/plan will provide payment for planned care. Performs detailed financial screening of benefits

Determines benefit coverage to ensure that it meets the standards and explains the financial requirements to the patient or responsible party and arranges/collects appropriate payments per financial screening policy

Develops accurate point of service collections communication and facilitates the collection of these payments

Maintains current knowledge of rules and regulations of industry and government programs, hospital financial and billing policies and educates patients, families, team members and other staff as necessary

Maintains extended knowledge base of payer and billing requirements for federal, state, local and commercial sources

Maintains and expands knowledge base of web-based applications used for determining eligibility

Participates in educational programs and in-service meetings to build upon current knowledge base

Maintains current, extended knowledge of hospital financial and billing policies

Acts as an educational resource for patients, families, the community and the hospital staff

Acts as an advocate of behalf of patients and families to enable patients/families to take full advantage of services which may be available to them

Assists in locating resources and/or assistance programs for which uninsured/underinsured patients may be eligible

Informs patients and clinical teams of anticipated gaps and or lack of insurance coverage

Interviews patients and or family members in person: advises patient with regard to next steps or process for securing financial coverage

Assists patients and or family members in completing applications to applying for resources with external agencies or hospital financial assistance in an accurate and timely manner

Continues to serve as a point of contact for patients/families throughout the completion of processes

Keeps Manager apprised of exceptions, high grade complaints and issues in a timely manner

Develops and maintains complete and accurate confidential patient financial records

Documents patient contacts and outcomes in the appropriate database in a thorough and timely manner

Follows HIPAA regulations and ensures that the confidentiality of patients’ medical, personal, financial records, employee records and organizational records is maintained

Establishes and maintains excellent working relationships with representative from insurance companies, government entities, Social Services, Utilization Management and Patient Financial Services

Performs Financial Clearance

Verifies eligibility and benefits for each patient

Obtains prior authorization/pre-certification as required by payer

Creates patient financial estimate as required

Presents and completes patient waivers as required

Documents all financial clearance notes, authorization numbers, and patient correspondence

Scans into the EHR system all necessary financial clearance documents

Works with Trac tool as required

Communicates effectively

Maintains close communication with billing offices and collaborates to resolve any billing and reimbursement issues. Facilitates resolution of patient billing issues

Shows patience and maturity when challenged by pressure and time restraints in resolving patient inquiries

Serves as a representative of the hospital, displaying courtesy, tact, consideration and discretion in all interactions with patients, coworkers and the general public in accordance with the Corporate Mission, Vision and Principles Statement

Performs other duties as assigned

Qualification

Financial screeningInsurance coordinationPatient advocacyBilling policiesEHR system proficiencyCommunication skillsInterpersonal skillsProblem-solving skills

Required