Non-Clinical - Administrative - Financial Administrative Representative

Financial Counselor POSITION SUMMARY The Financial Counselor ensures reimbursement to PIH Health from patients or other responsible parties and assists patients in understanding their health care insurance coverage by determining eligibility benefits authorization and utilization requirements and patient liability for specific department(s). The Financial Counselor is responsible for up-front collections and securing patients accounts by setting up appropriate financial arrangements with patients to avoid bad debt. The Financial Counselor when appropriate notifies patients of programs such as Medi-Cal VVC Uncompensated Care Cobra coverage Covered California and Hospital Presumptive Eligibility. Financial Counselors will focus on individual performance Key Performance Indicators and expediting approvals by gathering and completing forms before the patient is discharged. Financial Counselors will continue to enhance their registration and the fundamental financial knowledge and skill set required and expected of this role which is inclusive of the diverse financial program offered at PIH Health. ED & Urgent LDRP: Interaction with patients will only happen after a medical screening exam has been performed. All patients are seen regardless of their insurance coverage or their ability to pay. SPECIFIC SKILLS NEEDED Demonstrates a clear understanding of PIH Health mission and values Ability to work directly with the insurance company healthcare provider and patients Ability to generate revenue with payment arrangements collecting on accounts; monitoring and pursuing delinquent accounts. Legal Compliance knowledge and experience Demonstrated attention to detail and follow up process Demonstrated ability to communicate effectively and tactfully with patients healthcare providers and insurance company Excellent English reading comprehension and written skills to include spelling skills and penmanship Excellent Mathematical skills; ability to calculate and manage account figures and financial data Ability to follow directions as outlined in policies or given by supervisor Strong computer skills to include typing 45 wpm minimum and in MS office programs Excellent organizational skills Ability to exercise independent judgment at times of need and emergency situations Bilingual preferred Interacts with all levels of hospital and outside vendor staff and knowledge of government regulations Strong analytical skills problem solving. The ability to act and decide accordingly. Stringent adherence to all privacy policies and procedures and as required by state and federal law including and not limited to the HIPAA Security and Privacy Rules EDUCATION/EXPERIENCE/TRAINING Minimum of two year experience in medical billing front office and/or hospital registration/admitting Minimum of two year experience in insurance verification and/or front office medical/hospital billing. High school graduate required or equivalent prefer evidence of continuing education in Finance Accounting or Business Administration Knowledge of eligibility requirements for Medi-Cal Hospital Presumptive Eligibility Program Medicare Covered California Cobra limited benefit plans VVC and Uncompensated Care Programs. IPA knowledge Medical terminology required Excellent communication skills Demonstrate flexibility in adapting to change Strong analytical skills problem solving. The ability to act and decide accordingly. DUTIES AND RESPONSIBILITIES 1. Safeguards and preserves the confidentiality of patient s protected health information in accordance with State and Federal (HIPAA) regulatory requirements hospital and departmental policies. 2. Ensures a safe patient environment and adherence to safety practices per policy. 3. With consideration to age employee utilizes the approved process to resolve biophysical psychological educational and environmental needs of patient/significant other as required. 4. Guest Relations: Exhibits positive guest relations skills by displaying hospitality to patients physicians and their staff case managers employers payors co-workers and visitors at all times. Warmly greets these by name and introduces self by name. Uses the phrase How can I help you as a first line of communication finishing with the phrase Is there anything else I can assist you with before I go When contacting the patient or patient representative uses empathy anticipates concerns and provides an explanation. (Example: My name is . Im a financial counselor. I know this is a difficult time for you and that in addition to being concerned about your husbands health you are concerned about the hospital expenses for his care. I would like to assist you.....) Utilizes translators as necessary if available or new translating system Stratus as necessary to ensure patient fully understands the information being discussed with them. Displays a teamwork approach considering the impact of his/her decisions actions and behaviors on others. Works with the eligiblity workers and representatives to create a positive working relationship that will provide a smooth process for the patient. Responds to others in a constructive non-defensive manner. Maintains a professional appearance at all times as per policy. Expresses ideas clearly actively listens and always follows appropriate channels of communication. Ability to challenge and debate issues of importance to the organization Leads and Management. Maintains confidentiality at all times. Full disclosure is provided to patient when starting the interview and screening process for Hospital Presumptive Eligibility and/or Uncompensated application so they understand the process. 5. Organizational skills and Efficiency: Sets priorities integrates changes and organizes work activities in a logical and timely manner. Initiate and assist with the completion of the application process for HPE or Uncompensated benefits. Demonstrates a consistent level of performance and productivity by ensuring all insurance demographics and eligibility information is obtained and entered into the registration and financial system accurately and notifies appropriate hospital and vendor staff of changes. Always strives to make good use of time seeks out work that needs to be done (ex. runs assigned reports on a daily bases pre registers accounts to ensure financial documentation is entered in a timely manner etc.) reports free time to supervisors to provide assistance with another department if needed. Responsible for completing all assigned procedures during shift without sacrificing the quality of work. Responsible for communicating and documenting pending issues/authorizations etc. into the financial system to ensure everyone is current with account information. Contributes valuable insight on improving workflow. Limits personal phone calls to breaks and lunches. 6. Adheres to department specific expectations and procedures as documented in the appendix. 7. Flexibility: Demonstrates ability and willingness to work productively and efficiently in all financial counseling and/or registration departments at management s discretion. Exercises independent judgment in times of need and emergency situations while adhering to departmental and hospital policies. Demonstrates willingness to adjust schedule to meet departmental and census needs with a positive attitude. Provides financial insurance and registration assistance and information to patients physicians case managers department members and others as needed. Serves as a role model with new implementations for staff and always supports the vision of management with a positive attitude. Adapts current workflow to be a resource during high census or unexpected circumstances where registration or financial services are impacted. Serves as a resource to registration reps regarding insurance issues or education updates. Financial counselors will focus on individual performance key performance indicators and expediting approvals by gathering and completing forms before the patient is discharged. Welcomes the opportunity to take on new responsibilities and challenges; ability to adapt to change with a positive outlook. Complies with all Policies and Procedures demonstrate accuracy through attention to detail. (Minimum standard: 95% of all verifications must be 100% correct) To include but not exclusively: Reviews assigned patient visits and makes corrections into the computer as needed to demographic employer guarantor relative medical and insurance information as per policies. Utilizes all available tools to accomplish accurate verifications to include policies internet payer information and Passport Intellisource eligibility. Calls insurance visits payor website or uses eligibility system to verify and obtain current and accurate benefits. Calls for pre-certification/authorization and communicates with Care Management if clinical review is requested for additional approvals days for acute stay. Accurately keys verification and all patient activity related to reimbursement into our financial system and scans eligibility on applicable plans accordingly. Reviews each visit for missing content signatures such as consents COA HIPAA Important Message from Medicare and/or other required financial forms. Immediate follow-up with patient while in house or at home after discharge if needed. Collections: Emergency/Maternity/Urgent patients understand that services are provided regardless of ability to pay. Utilizes positive collection skills as per policy while complying with EMTALA laws. Notifies scheduled patients of their liability in an informative manner as outlined per policy. Financial Counselors are expected to request payment from all patients that have liability meet exceed and maintain monthly department collection goal every month set by VP of Revenue Cycle/ Systems Patient Access Director. Educate patients about their insurance coverage along with their financial responsibility in a clear and compassionate manner keeping in mind the mission and values of PIH Health Patients First vision which include the uncompensated care program and provision of assistance with the Medi-cal Hospital Presumptive Eligibility program. Financial Counselors will work on securing collections on delinquent accounts by establishing payment arrangements with patients; monitoring payments; following up with patients when payment lapses occur. Continues to work and maintain accounts on Self-Pay report to secure payment. Demonstrates successful collections skills by collecting payment/setting up payments for 75% of insured patients with liability and some form of payment for 33% of self pay patients that do not qualify for Medi-Cal HPE Covered California or Uncompensated Care. Utilizes the Patient Payment Estimator when applicable to calculate patient s financial estimate due. Enters payment in the Payment Navigator system. Demonstrates knowledge of PIH Health cash rate/Self pay discount program and Inpatient/Outpatient pricing. Responsible for accurately closing out cash and Payment Navigator reported front end collections daily M-F must correctly complete the Cash Reconciliation Report and turn into the Cashiers office before 10:00AM. All money from petty cash and in the department safe must be accounted and secured daily. Notify your Registration Supervisor when the Payment Navigator check reader needs maintenance or any discrepancy in cash totals. Growth: Demonstrates participation in the Performance Improvement program. Turns problems into opportunities for improvement. Demonstrates an active interest in improving current level of skill and knowledge by regularly reviewing Policy and Procedure on the internet home page including Disaster and Safety material. Attends and participates in each staff meetings as well as other hospital/job specific required education. Completes comprehensive training programs as required and set by management annually. Ability to follow directions as outlined in polices or given by supervisor. Maintains job knowledge by participating in educational opportunities. Enhances financial counseling department and hospital reputation by accepting ownership for accomplishing new and different request; exploring opportunities to add value to job accomplishments. Demonstrates willingness and ability to learn new skills and to adapt to change. Attendance: Adheres to attendance policy and provides notification of absence as per policy. Takes responsibility for keeping and knowing work schedule. Notifies supervisor far in advance of requests for schedule changes. PTO requests are made in a timely manner per department protocol. Time Correction forms are completed and turned in by your next scheduled shift. Keeps to a minimum request to leave early. Safety: Maintains a clean and safe work environment as per policy. Reports all problems immediately. Completes all required CBT s and annual health evaluations before annual review due date assigned by department supervisor. Performs other duties as assigned with professionalism. TEAMWORK/CUSTOMER SERVICE RESPONSIBILITIES: 1. Customer Service Values and Behaviors: 1.1 Value: Each person is treated with respect dignity fairness and compassion. Behavior: Performance is acceptable when everyone is promptly greeted with a smile in a warm and caring manner using the person s name whenever possible. Now matter how I feel I display a caring attitude. 1.2 Value: Each person displays loyalty and pride in PIH Health and upholds the confidentiality of patients visitors physicians and co-workers. Behavior: Performance is acceptable when concerns/problems with fellow employees and customers are not discussed with anyone other than the person involved or the supervisor. Customer issues and ideas are listened to and appropriate follow up occurs to create a satisfied customer. I do not make excuses. I do not demean other people or departments. 1.3 Value: Each person demonstrates commitment to open communication. Behavior: Performance is acceptable when openness and acceptance of constructive criticism occurs. Positive communication occurs by complimenting and expressing appreciation to others. I will listen and encourage others to express ideas and opinions. 1.4 Value: Each person demonstrates pride in the physical appearance of all PIH Health properties. Behavior: Performance is acceptable when the initiative is taken to maintain a clean and safe environment. I conduct myself in a manner which respects and preserves equipment and the physical plant. I do not walk by spills trash or unsafe conditions without assuring that they are attended to promptly by me or appropriate personnel. PERSONAL QUALITES: 1. Punctual 2. Effective communication skills organized dependable with a positive professional appearance and attitude 3. Must be able to handle multiple tasks at the same time. 4. Creative 5. Exceptional customer service and negotiation skills 6. Organizational skills analytical skills time management ability to work under pressure decision making and problem solving skills 7. High degree of accuracy and attention to detail 8. With consideration to age employee utilizes the approved process to resolve biophysical psychological educational and environmental needs to patient/significant others when administering care. 9. Ability to plan organize and exercise sound judgment 10. Ability to collect analyze and research complex or diverse information