[Hiring] Patient Financial Specialist @Prisma Health

Role Description

Understands the overall organizational goals for timely and appropriate resolution of accounts. Works in accordance with Patient Friendly standards consistent with policies and procedures ensuring complete, accurate, and compliant processes resulting in optimal collection and customer service performance for the organization. This includes the collection of deductibles, co-pays and co-insurances as well as payment towards accounts classified as self-pay.

• Performs in-depth demographic and financial assessments, generally at the bedside, to determine an appropriate payor source.
• Follows up from the assessment, which may include assisting the patient and contacting outside agencies such as Vocational Rehabilitation, Department of Health and Human Services, Social Security Administration, and others.
• Works collaboratively with Social Work and Outcomes Management to support their initiatives with ensuring the most appropriate continuum of care for the patient.

This position is 100% REMOTE.

Accountabilities

• Interviews patient and/or patient's representative (in accordance with HIPPA Guidelines) to obtain complete and accurate demographic and financial information.
• Possesses and demonstrates knowledge of computer systems and financial counseling processes allowing the ability to follow through with all assigned accounts timely and accurately.
• Exercises judgement in analyzing the information collected to ensure the patient receives every consideration for financial assistance.
• Ensures elimination of all possible payor sources prior to consideration of hospital sponsorship.
• Communicates patient's estimated financial responsibility and requests payment prior to or at the time of service, appropriately explaining insurance terms to the patient.
• Receives payments and issues receipts in accordance with departmental cash handling procedures.
• Monitors high dollar accounts that represent significant exposure to ensure complete and accurate financial and demographic information necessary for timely submission and reimbursement of the account.
• Initiates authorization and insurance verification processes as necessary and communicates changes to relevant departments.
• Coordinates and delegates referrals to the Department of Health and Human Services for application completion and monitors to ensure applications are secured in a timely manner.
• Demonstrates superior interpersonal relationship skills necessary for developing and maintaining positive professional relationships with patients, peers, clinical departments, payor organizations, and industry organizations.
• Maintains superior revenue cycle knowledge through ongoing review of governmental, managed care, and other third-party payor regulations and guidelines.
• Explores any possible payor source options such as Cobra, Liability, Worker's Compensation, or other Governmental Agencies.
• Contacts Social Security Administration and makes appointments for patients as needed.
• Assists the patient with the interview process and completing required forms as needed.
• Facilitates the disability determination process by working with clinical staff and disability examiner to gather necessary information.
• Exercises superior judgement in coordinating referrals to the appropriate outsource vendor for cases requiring additional follow-up after patient discharge.
• Completes special projects related to the revenue cycle as assigned, including participation with the complex patient review team and coordinating processes with Communicare.
• Exercises superior judgement in the elevation and determination of issues to be escalated to the appropriate management (internal/external).

Minimum Requirements

• High School diploma or equivalent OR Post High School Diploma.
• 3 years - Health Care Revenue Cycle Experience (such as Billing, Collections, and/or Customer Service).

• In Lieu Of The Minimum Requirements Listed Above: Bachelor's degree and 3 years experience in a service industry may be substituted for the above education/experience requirements.

Work Shift

Day (United States of America)

Location

Richland

Facility

Corporate

Department

Financial Counseling

Company Description

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.