Under the general direction of the Patient Access Coordinator, and within the established policies and procedures the Patient Access Financial Counselor is responsible for the efficient and successful counseling of patients who have identified specific financial needs. He or she will provide patients with all available financial options- in accordance with regulatory agencies, to include financial counseling and financial clearance for pre-admissions, admissions, pre-registration and registrations as well as -, insurance verifications and financial liability collection.- This position is responsible for researching, verifying and obtaining accurate demographic-, insurance and financial information. Responsibilities also include obtaining - the authorization number/providing notice of admission, maintain knowledge of payor - authorization requirements; investigating and responding to all financial inquiries - related to a patient’s hospital stay from patients, physicians, physician office staff and any other hospital entities requiring the information .
1. Monitors, evaluates and follows-up on daily Census for new admissions, status change updates. .
2. Analyze insurance coverage and benefits for services ensuring, verifying all prior authorization requirements with the payor and initiating the notice of admission (NOA) as appropriate to ensure accurate and timely reimbursement.
3. Analyze and identify financial liability for insured, uninsured and underinsured patients. -Calculate and collect payments appropriately for all patients, including prior account balances; escalate payment concerns, discuss payment and financial assistance options. Effectively communicate and collect financial responsibility and provide financial options to the patient and/or responsible party through face-to-face financial counseling either at one point of admission, in the admitting department and/or bedside during the patients stay. Provide the patient and/or responsible party with a financial responsibility document/letter and -ensure daily reconciliation of - cash collections -.
4. Determine if patient’s condition is the result of an accident - perform complete research as needed to determine the appropriate source of liability/payment.
5. Review accounts for accuracy and quality, correct- demographic- and financial data as necessary. Provide registration support and feedback as appropriate.
6. Resolve all system edits and remedy expediently including daily work queues, reports and audits. -.
7. Interact with Social Workers, Case Managers, Nursing Units and Third Party vendors related to patient financial concerns, assistance, authorizations and compliance.
8. Promote and maintain the highest quality level of service excellence for all customers, exhibiting a welcoming environment.
9. Maintain privacy and confidentiality standards as an expression of respect for the discretion and dignity of each person. Effectively demonstrate the mission, vision and values of NHRMC and observe all regulations mandated by Health Insurance Portability and Accountability Act (HIPAA).
10. Maintain general knowledge of CMS guidelines and third party payors -, specifically- Medicare, Medicaid, Commercial insurances, HMO’s, PPO’s, POS, indemnity plans, - Worker’s Compensation and auto or liability - payors; make referrals to appropriate vendors for admission criteria/financial clearance as appropriate.
11. Provide Patient Access on-call coverage for all network registration areas.
* High School Diploma
1. Education: Required: High School diploma required. College degree preferred.
2. Licensure / Certifications: Certified Patient Access Technician (CPAT) or Certified Health Access Associate (CHAA) certification preferred.
3. Experience: Minimum two-year healthcare finance/business office and/or admission office experience in health care setting with computer knowledge and data entry.
Demonstrates standards of performance (ownership, teamwork, communication, compassion) that support patient satisfaction and principles of service excellence.
Performs other duties as assigned.
Individual will possess commensurate combination of education, experience and qualifications.