OBH Financial Counselor
The Financial Counselors assess all aspects of patient financial account management for all outpatient and partial visits. The Financial Counselors are accountable for coordinating all activities necessary to secure the defined caseload through the verification process; resolving complex problems that include but are not limited to pre-certifications; coordination of benefits; eligibility discrepancies; Cobra entitlement; and Medicare Advantage issues. This role involves in-depth communication, collaboration, and follow-up with patients; families; third-party payers; governmental agencies; employers, social work, financial case management, clinical team including serving as a liaison to Finance and third-party payers on negotiating rates.
This role may have the option to work a Hybrid-remote schedule and communicates daily through virtual meetings.
SUPERVISION AND DIRECTION EXERCISED :
Responsible for monitoring own performance on assigned tasks. Self-directed and must make complex decisions independently. May be involved in training other support staff.
MACHINES AND EQUIPMENT USED :
Standard office equipment includes telephone, Softphone, page system, pneumatic tube system, personal computer, printer, photocopier, fax, Right Fax and third-party verification systems.
TYPICAL DUTIES :
Customer Interactions - Essential 10 %:
Creates a professional and effective customer-oriented environment by utilizing excellent communication skills to obtain pertinent demographic information; confirms insurance information; discusses financial obligation; confirms the patient agreement signature is on file; documents demographic and insurance information in a timely manner in the hospital computer system following department and hospital standards.
Financial Management – Essential 75 %:
Reviews each visit for insurance history by utilizing the hospital system along with all third-party payer systems.
Obtains benefits, pre-certification requirements and notifies the clinical team of clinical requests.
Identifies and confirms self-pay patients for appropriate referral to Financial Case Management for possible Medicaid application or Financial Assistance.
Identifies pre-existing conditions and restricted recipients during the insurance verification process for proper follow-up.
Notifies the appropriate provider on patients who are at their Threshold limit.
Initiates notification to providers when a patient is considered a restricted recipient.
Determines the primary payer through knowledge of Medicare and other payer regulations for the coordination of benefits.
Maintains a monitoring system for adequate benefit coverage and eligibility for future appointments.
Accountable for meeting department standards for completion and QA of visits on a day-to-day basis by ensuring that missing registration items are complete and the referral record is updated with the authorization number.
Reviews denial management report for resolution or possible write-off.
Quality- Essential 15 %:
Monitors current appointments to ensure eligibility, coverage, and service authorization.
Confirmation of authorizations for services being rendered up to 14 days before the appointment.
Notifies clinical team for clinical review with third-party payer, follows-up if applicable, and updates referral record accordingly.
Observes departments DAR daily for potential cases that may require notification to insurance companies of services.
Observes departments DAR daily for self-pay cases that may need a referral to FCM.
Monitors workqueues daily for errors that are holding the billing process.
Reviews Medicare for MSP questions and validation.
Checks Medicaid eligibility every 30 days for active coverage.
Attends educational programs for the department at the Manager's direction.
May train or perform other duties assigned by management.
AAS in a related discipline (admitting/registration/patient billing/insurance) with 3 years of related experience, preferably in a hospital setting or an equivalent combination of education and experience. Require a high degree of professionalism and motivation with excellent communication and customer service skills, strong computer skills, and the ability to type 25 words per minute. Prefer medical terminology. Flexible to work weekends, other assigned hours, and responsibilities as needed.
NOTE : This document describes typical duties and responsibilities and is not intended to limit management from assigning other work as required.
The University of Rochester is committed to fostering, cultivating, and preserving a culture of equity, diversity, and inclusion to advance the University’s mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other status protected by law. This commitment extends to the administration of our policies, admissions, employment, access, and recruitment of candidates from underrepresented populations, veterans, and persons with disabilities consistent with these values and government contractor Affirmative Action obligations.
How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled
Pay Range: $ 18.50 - $ 24.71 Hourly
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Location: Strong Memorial Hospital
Full/Part Time: Full-Time
Opening: Full Time 40 hours Grade 009 Financial Counseling & Outpt Reg