FINANCIAL COUNSELOR INPATIENT PER DIEM

US:NV:Carson City Patient Registration

Per Diem Variable Shift

Summary

The individual's responsibilities include but not limited to the following actions: a) Maintains current knowledge of state/county/hospital financial assistance programs, b) Assists patients without a payer source in identifying possible areas for assistance, c) Assists with completion of assistance applications, d) Obtains and maintains accurate data collection in order to identify areas of opportunity in the patient accounts process, e) Follow up on each account during the patient stay to ensure paying source and or notification/authorization is secured.

Qualifications

Required:

• Three (3) years of experience in a healthcare setting
• Experience performing insurance verification, eligibility review, and patient financial responsibility discussions
• Proficiency using electronic medical record (EMR) systems and standard computer applications
• Ability to obtain Nevada Medicaid Hospital Presumptive Eligibility Certification within one (1) year of hire

Preferred:

• Experience in acute care hospital financial counseling
• Experience using Epic EMR, particularly patient access or financial workflows
• Knowledge of medical terminology
• Experience assisting patients with Medicaid, charity care, or other financial assistance programs

Essential Functions

• Reviews daily admissions validating effective coverage/benefits and submit appropriate admit notification to commercial, government, or third party liability payers within one (1) business day
• Provides required clinical review information to appropriate UR organization based upon the health plans guidelines and criteria for admission
• Reviews daily uninsured admissions to assist patient and/or family with financial arrangements and identification of pay source
• Maintains knowledge to effectively communicate to patient/family eligibility requirements and process for Medicaid and Hospital Financial Assistance
• Completes outside agency financial application forms with guarantors in a timely manner
• Reviews and ensures compilation of hospital financial assistance applications, presenting to appropriate leader and hospital committee for consideration
• Works with hospital staff, particularly Case Management as requested to ensure that all avenues for possible pay sources have been reviewed for uninsured and underinsured patients
• Maintains and uses various payer portals to research/validate coverage, benefits, and notifications as needed
• Validates patient's demographic and payer information and notifies Patient Access immediately if any corrections are needed
• Provides detailed account notes on actions taken, correspondence, communication, authorizations and denials in the electronic medical record
• Participation in department quality improvement initiatives and projects as assigned
• If applicable, ensures that timely clinical reviews are made for continued lengths of stay authorizations.
• Applies problem-solving skills to the interdisciplinary team process
• Adheres to policies and procedures to comply with the CMS Conditions of Participation
• Ability to explain insurance benefits, payment options, and financial assistance programs clearly to patients and families
• Ability to work independently and as part of an interdisciplinary team
• Strong organizational, time-management, and problem-solving skills
• Professional verbal and written communication skills
• Ability to interpret patient account and eligibility data
• Performs other related duties as assigned