The Patient Financial Representative (PFR) is the main financial contact for patients with self pay balances and/or without adequate financial resources. The PFR looks after the financial interests of the organization by securing sponsorship for patients unable to pay and collecting from patients able to pay. The PFR interacts with patients prior to service through financial counseling at the time of pre-registration and pre- certification, at the time of service through bedside financial counseling, point of service collections, and after service collections through tracking of Medicaid, SSI, SSDI, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance applications, bank loan program, and telephone collections.


Essential Job Functions


• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Performs financial counseling for self pay, MVA, and commercial insurance patients with deductibles greater than established guidelines, resolves any issue that the patient presents from areas in the hospital, clinics, nursing home, and other areas of Billings Clinic. Duties include interviews with patient and family members, identification of potential eligibility for SSI, SSDI, Medicaid, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance program and promotion of bank loan program. As each patient's needs differ, assesses the situation and initiates the appropriate method to recommend/resolve the patient's concern/dispute/issue.
• Completes daily follow-up on outstanding self-pay balances. Daily performance includes but is not limited to speaking with patients in person, making and receiving telephone calls, establishes and monitors payment plans per policy and procedures and renegotiates payment plan arrangements when new accounts are combined into the payment plan or when patient's circumstances change. Negotiates within established guidelines discounts with customers, including patients, attorneys and collection agencies. Dispute resolutions coordinating/working with Risk Management, Department Managers, Coding and Compliance, Insurance, Physicians, and any other area necessary to resolve the patient issues. Obtains HIPAA authorization forms, reviews and resolves issues identified in daily correspondence/ interoffice mail and replies to patient either by return mail or by phone. Performs customer service by providing assistance to customer inquiries including account information, insurance billing issues, and quality of care issues as appropriate. Coordinates with other departments as appropriate and advises patients about the outcome.
• Coordinates financial counseling efforts with entities of Billings Clinic, other physician's offices, other community health care providers and patients regarding insurance related information, procedures cost and charge estimates, coverage issues, and options for patients without insurance. Provides itemized statements needed by patients for their flex plans and other insurance coverage requiring a statement from the patient.
• Accepts over the counter cash, check, credit /debit card payments, check by phone, completes employee payroll deduction forms, and finalizes bank loan paperwork with patients. Monitors, posts and adjusts on all collection agency payments.
• Evaluates self-pay account balances for transfer to bad debt and assignment to outside collection agencies. Handles all functions required under bankruptcy discharges and requirements.
• Utilizes performance improvement principles to assess and improve quality.
• Provide Financial Counseling as a Certified Application Counselor for the Health Insurance Market Place
• Identifies needs and sets goals for own growth and development; meets mandatory organizational and departmental requirements.
• Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.
• Performs other duties as assigned or needed to meet the needs of the department/organization.