Financial Counselor

Beloit Health System is looking to add a Financial Counselor to our Revenue Cycle Team!

• Shift: 1st

• Schedule: 8a - 4:30p

• Hours per week: 40

• Benefits Status: Eligible

• Department: Beloit Clinic Insurance/Billing

Financial Counselors are responsible for performing various financial clearance functions, including but not limited to preparing estimates, helping patients and/or their representative navigate and understand insurance benefits, as well as potential financial liabilities. Financial Counselors are the patient's point of contact for financial assistance questions.

These individual collects payments, sets up payment arrangements as appropriate, creates estimates, advises patients in person and over the phone on their insurance benefits and coverage, and assesses patient referrals for appropriateness. The incumbent assists patients with eligibility for government programs, Beloit Health System's financial assistance program, and other options for managing high medical liabilities. This position works closely with outpatient and inpatient scheduling areas to ensure all patients are financially cleared and screened for financial risk before receiving services.

• Serves as the point of contact for all financial assistance related questions.
• Communicate with patients to identify and understand financial, social, and medical histories and other relevant patient information needed to assist in managing medical liability.
• Gather all relevant information required to process financial assistance requests; including but not limited to working with providers on treatment plans, best practices, and related necessary medical opinions.
• Document all communication and follow up in the EMR
• Assess the current financial situation of patients through the verification of patient insurance benefits; serving as the technical expert in confirming patients benefit coverage and hospital reimbursement:
  1. Determine the patient's financial ability to pay and explain insurance coverage and benefits to the patient.
  2. Initiate the financial screening process as appropriate to evaluate eligibility for assistance programs.
  3. Assist the patient in completing financial statements and gathering supporting financial documentation.
• Determine eligibility for care at BHS for Medical Assistance, Emergency Mdical Assistance, Community Programs, and Government Programs:
  1. Assess and offer payment alternatives which may include prepayment for elective care, applying for BHS's financial assistance program, alternative treatments, or receiving care closer to home.
  2. Consult with Business Office, Clinicians, Leadership, and Referring Physicians to make determination regarding appropriateness of the request when in conflict with third party payors,
  3. Identify eligible financial programming options and assist in completing all necessary documentation for specific federal, state, or UW Health financial assistance programs.
  4. Assist in obtaining exceptions to the out of network determinations from insurance companies, escalate if necessary
  5. With provider involvement, determine urgency of scheduled care for patients with large financial liabilities resulting in either a decision to proceed or a decision to obtain sponsorship.
• Explain BHS payment policy to patients if a program is not available. Calculate and explain any patient liability before or at the time of elective service.
• Counsel patients on out-of-pocket liabilities. Collecting deductibles, pre-payments, and outstanding balances following established collection procedures; or alternatively, creating payment plans and document the agreement appropriately.
• If unable to establish acceptable payment arrangements for elective procedures, inform provider and patient that services will be rescheduled or cancelled.
• Communicate financial coverage status and applicable financial decisions with all appropriate parties: patient, family, referring clinicians, and UW Health clinicians. UW HEALTH
• Uses established key indicators of financial risk to screen accounts to identify patients that may have trouble making payment (e.g. (uninsured, underinsured, non-covered service, etc.)
• Meet with patients face to face or via telephone to counsel patients/customers on billing concerns, account balances, services costs/estimates and various insurance resources.
• Maintain a knowledge base of programs offered through the government, the insurance marketplace, and the Beloit community.
• Screens self-pay patients for presumptive eligibility, Medicaid or other programs; performing necessary follow-up to ensure application and subsequent coverage takes place.
• Responsible for meeting Patient Access department guidelines for daily patient contact, collection goals, and department benchmarks.
• Research denied claims through review of system/account/process to reconcile information.
• Performs insurance verification and pre-certification activities for procedures when necessary.
• Work with patients determined to have financial risk to set up agreeable payment plan or apply for financial assistance.
• Prepares estimates for scheduled services on self-pay or covered services where amounts are expected to be applied to patient share by health plan. Reviews this estimate with patient, working with and helping patient to plan for financial obligation associated with estimate.
• Communicates patient liability clearly and accurately while adequately explaining concepts such as deductibles, coinsurance, and/or co-payments and how they may affect the cost of care.
• Delivers and explains regulatory documents such as Medicare Outpatient Observation Notice (MOON) and Self-Administered Drug (SAD) notification to patients at bedside.
• Handles all communication (telephone, email, interpersonal) with patients and other departments within Patient Financial Services; Responds to all patient correspondence in a prompt and courteous manner.
• Research denied claims through review of system/account/process to reconcile information.
• Performs insurance verification and pre-certification activities for procedures when necessary.
• Clearly explains service charges to customers, reports any charge/payment errors to manager, and resolves any errors within Beloit Health System's billing system
• Pursues collections on accounts receivable self-pay balances, Updating patient demographics when necessary
• Collects patient payments made over the counter, over the phone, and by mail on a daily basis; properly records all payment types (e.g., cash, check, debit, credit) and transactions into the computer system
• Represents Health System in legal proceedings related to patient balance resolutions.
• Provides exceptional customer service that aims to improve patient and/or guarantor relations and contributes to a positive work environment
• Engages in continuous professional development by attending staff meetings, educational seminars, and workshops
• Provides improvement recommendations, communicating observed trends and issues supervisor to
• Demonstrates knowledge of Beloit Health System's safety policies and procedures maintaining a safe environment by
• Follows departmental policies and procedures, meeting or exceeding established expectations, attendance, and productivity standards.

Job Requirements

• High school diploma or GED certification is required
• Associate degree in accounting, healthcare finance or an equivalent with two years medical office/facility billing and computer experience; any combination of education and experience that provides equivalent knowledge, skills, and abilities may be evaluated and accepted in lieu of degree requirement.
• Minimum of 5 years hospital and professional third party and self-pay billing experience
• Minimum of 5 years customer service experience in a hospital and professional office setting
• Knowledge of basic patient accounting processes and healthcare terminology strongly preferred
• Strong math and situational reasoning skills as demonstrated through competency assessment.
• Strong computer skills (including MS Word and Excel) as demonstrated through competency assessment.
• Ability to maintain accuracy while working on multiple tasks in a fast-paced environment under low-to moderate supervision.
• Excellent verbal and written communication skills
• Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance
• Dependable in attendance, production and quality of work
• Exceptional organization and time management skills
• Must adhere to established Hospital and Revenue Cycle department policies, rules and regulations.
• Maintain ethical conduct and keep confidential personal and medical information about patients.
• Reporting Relationship: Managers of Business Operations and/or Patient Accounts

BEHAVIOR AND ATTITUDE

The mission of Beloit Health System, Inc. is to be the leader in regional health and wellness services that delivers high quality value and satisfaction to our patients and communities we serve.

Beloit Health System requires the employee to maintain integrity as a fully engaged employee. Each employee will perform in a manner which ensures delivery of the highest quality of medical services and patient satisfaction. Respect and consideration given to the dignity of each patient, visitor, and fellow employee is a requisite of successful job performance.

The above statements are intended to describe the essential functions and related requirements of personas assigned to this job. They are not intended as an exhaustive list of all job duties, responsibilities, and requirements