[Hiring] Revenue Cycle Financial Counselor @Wilbarger General Hospital

Role Description

The Financial Counselor is responsible for providing patients with a positive financial experience by helping them navigate and understand insurance benefits and potential financial liability. Financial Counselors are the patient’s point of contact for financial assistance questions. The Financial Counselor 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 in some cases, assesses patient referrals for appropriateness. The incumbent assists patients with eligibility for government programs, WGH’s financial assistance program, and other options for managing high medical liabilities. Independent judgment and decision-making is required to address the full range of tasks and responsibilities. The position requires the ability to plan, schedule, and organize numerous tasks that directly impact hospital and physician reimbursement.

Essential Job Functions

• Serve 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.
• Gather all relevant information required to process financial assistance requests, including:
  • Working with providers on treatment plans, best practices, and related necessary medical opinions.
  • Documenting all communication and follow up in the EHR.
• 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:
  • Determine the patient’s financial ability to pay and explain insurance coverage and benefits to the patient.
  • Initiate the financial screening process as appropriate to evaluate eligibility for assistance programs.
  • Assist the patient in completing financial statements and gathering supporting financial documentation.
  • Complete the referral pattern for patients with financial risk.
• Determine eligibility for care at WGH by assessing patient eligibility for Medical Assistance, Emergency Medical Assistance, Community Programs, and Government Programs:
  • Assess and offer payment alternatives which may include prepayment for elective care, applying for WGH’s financial assistance program, alternative treatments, or receiving care closer to home.
  • Consult with WGH Business Office, Clinicians, Leadership, and Referring Physicians to make determination regarding appropriateness of the request.
  • Identify eligible financial programming options and assist in completing all necessary documentation for specific federal, state, or WGH financial assistance programs.
  • Assist in obtaining exceptions to the out of network determinations from insurance companies, escalate if necessary.
  • 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 WGH payment policy to patients if a program is not available.
• Calculate and explain any patient’s liability before or at the time of service.
• Counsel patients on out-of-pocket liabilities.
• Collect deductibles, pre-payments, and outstanding balances following established collection procedures; or alternatively, create a payment plan with the patient 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.
• Complete bad debt and charity care paperwork/projects.
• All other duties as assigned.
• Cross Training in other departments.

Customer Service Standards

• Support co-workers and engage in positive interactions.
• Communicate professionally and timely with internal and external customers.
• Demonstrate friendliness by smiling and making eye contact when greeting all customers.
• Provide helpful assistance in anticipating and responding to the needs of our customers.
• Collaborate with customers in planning and decision making to result in optimal solutions.
• Ability to stay calm under pressure and deal effectively with difficult situations.

Qualifications

• Knowledge of office management systems and procedures.
• Proficiency in MS Office (MS Excel and MS Word).
• Excellent time management skills and the ability to prioritize work.
• Attention to detail and problem-solving skills.
• Ability to work in a busy, loud, and demanding environment.
• Must independently recognize and evaluate situations for the level of urgency.
• Experience in providing a high level of customer service.
• Strong emotional intelligence and empathy.
• Excellent written and oral communication skills.
• Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff, and the general public.
• Must be detail oriented and accurate.
• Ability to multi-task and prioritize tasks.
• Displays an aptitude and willingness to learn new responsibilities.
• Willingly accepts feedback.
• Flexible and innovative.
• Ability to solve problems and work independently.
• Displays a professional appearance.
• Dependable and reliable in achieving goals.
• Experience operating office machines such as personal computers, fax machines, photocopiers, and document scanners.
• Familiarity with medical terminology and abbreviations.
• Proven ability to maintain confidentiality of sensitive information.
• Reliability.
• Teamwork.
• Integrity.