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Job Description
Financial Counselor 8590 #13811
Job #: 13811
Job Category:
Patient Access
Job Type:
Full Time
Shift Type:
Days
Department:
Financial Counseling
Pay Range:
$22.57/hr. - $30.33/hr.
Open Date:
06.18.26
Close Date:
Qualifications:
High School graduate or equivalent required
Two years of hospital experience and working knowledge of all patients accounting functions, including pre-admissions and admission registration
Demonstrated experience in credit, collection and billing is required, preferably in a hospital setting
Knowledge of medical and insurance terminology is required
Ability to type 45 WPM
Job Details:
Start Date:
Open Until Filled.
Qualifications:
High School graduate or equivalent required
Two years of hospital experience and working knowledge of all patients accounting functions, including pre-admissions and admission registration
Demonstrated experience in credit, collection and billing is required, preferably in a hospital setting
Ability to interpret billing manuals, insurance and/or other third-party coverage
Understanding of the third-party review process
Understanding of payer funding and authorization procedures to ensure payment
Understanding of government/state payers, including eligibility factors
Knowledge of medical and insurance terminology is required
Ability to type 45 WPM
Must be proficient in the use of office machines, including computers
Must have excellent interpersonal and telephone skills
Must have effective written and verbal communication skills
Must posses patient interview techniques
Must obtain the ability to prioritize workload and possess ability to meet tight time frames
Must obtain the ability to work under minimal supervision, is detail oriented and possess problem-solving skills
Must be able to withstand a frequent amount of working at a computer terminal
Must obtain the ability to concentrate on detail in the middle of other activities
Duties & Responsibilities:
Job Summary The Financial Counselor performs the quality control function for inpatient accounts, outpatient surgeries and outpatient radiology, ensuring all pertinent information is available and accurately documented, allowing for timely and efficient billing. These activities include generating weekly status reports, communication with multiple departments, monitoring accounts for proper documentation of third party review notification, authorizations, insurance verifications, collection of deposits and self pay balances, securing reimbursement methods of non-insured admits, computer update of accounts and the collection of verification of relevant patient data. Duties Follows policy and procedures in regard to financial screening, arrangements and third-party demands
Verifies and assures all accounts are ready for billing with adequate supporting documentation, within the established time frames
Serves as support to patients and their family members to assure customers have access to all available funding, this involves; working with private as well as governmental agencies; i.e., private insurance, HMO/PPO's, Medi-Cal, Medicare, Champus and Worker's Compensation
Initiates and completes charity applications on accounts at risk for completing Medi-Cal application requirements and installment agreements
Maintains daily contact with Utilization Management, Business Office, Patient Registration, Medical Records, Ancillary departments, various third-party agencies, HMO/PPO's, patients, their families, physicians, offices and other outside entities
Reviews financial data to determine possible Medi-Cal eligibility and verifies with
POS/AEVS
Assists patients in completing State and county medically indigent application forms and schedules appointments for patients with on-site County eligibility worker
Determines possible eligibility for charity assistance, Charity Policy, Proposition 99 Funding, and SB12
Prepares accounts for Supervisor's approval
Bills appropriate state or federally funded programs and follows required procedure for patient eligibility and/or transfer
Determines patients ability to pay and secure repayment arrangement with patient, according to Oroville Hospital established polices Provides comprehensive audit and analysis
Updates all inpatient, outpatient, and surgery accounts to ensure completeness and accuracy
Exercises problem solving skills independently and update system to resolve any patient account delay
Monitors appropriate turn around on all accounts to ensure the business office within established time frames receives accounts
Assures proper financial classification, determines proper guarantor and updates system accordingly
Verifies Medicare eligibility utilizing DDE for appropriate coverage relation to service to be rendered
Identifies if an HMO or Hospice is managing Medicare benefits
Performs third-party certification/verification on Medicare HMO accounts
Verifies Medi-Cal coverage for other coverage and restricted services
Investigates Medi-Cal overage for other coverage and restricted services
Obtains needed authorization for scheduled Medi-Cal accounts requiring 50-1 and forwards to Utilization Management when received
Always handles all patient/family contact in a courteous, professional manner
Consistently interacts with sensitivity to patients/their families and is responsive to individual needs
Receives and places telephone calls in a skillful manner using appropriate etiquette
Handles all telephone requests with courtesy, accuracy and respect for confidentiality
Provides estimates for procedures to patients, physicians' offices, and payers as requested Consistently follows/reviews third-party guidelines for review notification and contract coding of patient accounts
Alerts Supervisor/Director to patterns in problem areas in order to initiate situation resolution
Alerts Supervisor if extended payment arrangements are needed to obtain approval from UM Director
Reviews each account for specific third-party billing requirements, including necessary document for prompt billing
Coordinates necessary activities with external review agents to ensure timely receipt of all third-party certification required for billing
Review account to assure that all third-party identification codes are used correctly according to documentation in computer system
Staff resource to hospital departments for information related to documents and other information necessary for billing
Contacts referring provider in a timely manner if needed authorization is not initiated on scheduled accounts
Utilizes UM Department as a resource for scheduled accounts when authorization cannot be obtained prior to service to determine medical urgency
Reviews daily pre-op, surgery and outpatient schedules generated to ensure account information is complete prior to services rendered Obtains necessary referrals, authorization and pre-certifications as needed
Obtains patient demographic data not captured during scheduling process, which is necessary for claims processing
Determines co-pay, share of costs and deductible status using information obtained during verification process
Contacts patient prior to service to advise of Oroville Hospital's policy regarding co-pay and prepares installment agreement, if needed
Documents accounting in billing revisions and notes to include verification, authorization, and co-pay to be collected by Patient Registration Representatives at time of procedure
Forwards all needed paperwork for outpatient procedures to Patient Registration Representatives to be added to account folder to ensure timely billing
Completes and submits a weekly cash collection report
Completes and submits a weekly productivity report
Demonstrates commitment to total quality management through knowledge of its precepts, skillful workplace applications and continuous organizational improvement
Exhibits a customer/supplier philosophy that emphasizes both internal and external relationships
Identifies both customer and supplier needs/expectations and strives to exceed them
Actively participates in and encourages others to utilize creative and innovative approaches to accomplish tasks
Demonstrates responsibility for ongoing personal development, professional growth and continuing education
Performs duties in a self-directed manner with minimal supervision or direction
Ensures that routine and priority tasks are completed within established departmental time frames
Demonstrates a clear understanding of and consistently adheres to department and facility policies and procedures
Attends and actively participates in department and facility meeting and classes, including annual fire, safety and disaster programs
Follows safety procedures, operates equipment and performs job related duties in a safe manner which prevents accidents from occurring
Performs other duties as assigned
Lifting Requirement:
This position requires repetitive motion (i.e. bending, stooping, twisting, walking, standing, sitting, reaching overhead, pulling or pushing). Manual dexterity required. Sedentary- generally not more than 10 lbs. maximum and occasionally lifting and/or carrying such articles as ledgers, files and small items.