Job Title: Financial Counselor

Department: Business Operations

Reports To: Business Operations Manager

FLSA Status: Non-exempt (hourly)

Work Schedule: Monday-Friday, 8:00 A.M. - 5:00 P.M.

Summary: The Financial Counselor is responsible for analyzing account data and upcoming appointment data to provide effective counseling to patients while ensuring that the practice receives adequate payment for services rendered. Job duties must be completed in line with the practice's core values of Excellence, Innovation, Collaboration, Advancement, Stewardship, and Patient Centered Care.

Essential Duties and Responsibilities:

Quality and Customer Focus:

• Explain bills and provide assistance to patients
• Explain OEI financial policy to patients and staff
• Answer patient calls and requests promptly and efficiently. Return all messages withing 24 hours
• Provides patient services utilizing excellent customer service skills
• Counsel patients about their insurance coverage and benefits, including deductible, copay, coinsurance and estimated out of pocket costs
• Meet with patients/guarantor to discuss their out-of-pocket costs for their recommended treatments and determine payment plans and other financial accommodations to pay for those treatments
• Contact insurance carriers or other sources and act as an advocate for the patient
• Document payer requirements for services on patient's accounts
• Consistently document all conversations and discussions with payer, patient, provider, and other OEI staff on patients' accounts in practice management system.

Financial Management:

• Update the billing system to reflect the insurance status of the patient
• Analyze insurance coverage and benefits for services to ensure timely claim filing
• Facilitate payment sources for uninsured patients and assist with any financing or third-party applications
• Issue financial clearance for treatment of patients
• Prepare, print and mail collection letters to patients
• Calculate amounts due according to credit and collection policies
• Collect cash payments appropriately for all patients
• Communicate with insurance carriers regarding clinical information requested and to resolve issues relating to coverage
• Examine insurance policies and other third-party sponsorship materials for sources of payment
• Determine if patient's condition is the result of an accident and perform complete research to determine the appropriate source of liability/payment
• Assist insurance team to resolve insurance claim rejections/denials and remedy expediently
• Review practice management reports to make referrals for financial counseling
• Inform attending physician of patient financial hardship
• Calculate and collect patient out-of-pocket expenses for scheduled surgical services.
• Maintain collection records for monthly reports to share with management.
  

Job Knowledge, Organizational and Operational Skills

• Communicates with front office staff, clinical staff, and patient accounting regarding scheduling, patient treatment and financial counseling needs
• Maintain current knowledge regarding payer policies and procedures
• Perform those duties necessary to ensure all accounts are processed accurately and efficiently
• Gather necessary documentation to support proper handling of inquiries and complaints
• Properly document all account activity in Electronic Medical Record systems
• Set up, maintain and edit payment arrangements in the practice management system on account when established
• Admit, register, and pre-register patient with accurate patient demographic and financial data

Required Behaviors:

• Excellent written and verbal communication skills required
• Ability to prioritize tasks and work independently
• Must be highly organized to successfully manage multiple tasks simultaneously
• Must demonstrate professionalism through appearance and extensive interactions with others
• Exhibit pleasant, professional telephone etiquette at all times

Education and/or Experience:

• High School diploma or GED required
• Knowledge of medical billing requirements, third part payers, coordination of benefits, scheduling practices and provider template management required
• Minimum of two years of medical office experience preferred, preferably in an insurance or collections position
• Knowledge of managed care referral and prior authorization requirements
• Experience in maintaining confidentiality in dealing with sensitive issues
  

Physical Demands:

• Extended periods of sitting, keyboarding, and talking on the telephone
• Occasional lifting and/or moving up to 10 pounds
• Extended periods of standing