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Duties &
Responsibilities:
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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
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Other Info:
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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.
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