The Patient Financial Counselor reports directly to the Manager of Patient Financial Services. The Patient Financial Counselor functions is responsible for the in-depth evaluation of financial history for both uninsured and underinsured patients for the purpose of determining eligibility for government assistance programs. The Patient Financial Counselor will serve as the primary practice contact when patients require assistance with various billing/financial related issues, which cannot otherwise be resolved by Patient Billing Solutions. As a Patient Financial Counselor, you will be responsible for ensuring patients are appropriately financially covered for their medical needs and are an essential component of the healthcare revenue cycle, working with patients, clinicians, insurance companies, and healthcare administration to ensure patients are financially cleared to have medical and surgical services. The Patient Financial Counselor will work collaboratively with BWPO Practice Management, Patient Billing Solutions, Patient Services Center, Patient Relations, BWPO Billing Agencies, the Office of General Counsel, and State Agencies, e.g., EOHHS, DHCFP, etc.
In addition, the Patient Financial Counselor will act as a department resource, which may include assisting in the training of new hires, or the retraining of existing hires.
Schedule: Hybrid
The individual can expect to work onsite at the main campus on 75 Francis Street in Boston, MA for probationary period before moving to a hybrid work schedule (3 days in office/2 days remote). The hours are 8:00am - 4:30pm and 8:30am - 5:00pm.
Benefits:
Full benefits: Medical, Dental, Vision, 403b retirement and match, Pension, STD, LTD
PTO - 30 days per year
Weekly pay
Discounted MBTA pass
Education Reimbursement
What does a day look like in this role?
Performs financial assessment for individuals that are uninsured and underinsured to determine eligibility for state, federal and private insurance programs.
Help patients apply for and or understand all financial assistance programs such as MassHealth, MassHealth Longterm Care, ConnectorCare, Health Safety Net, PHS Financial Assistance and Medicare Part D the Medicare Low Income Subsidy Program.
Assist patients with applying for community out of state Medicaid for New England states only
Register patients by obtaining, verifying, and recording personal, demographic, and financial information in a sensitive and timely manner, ensuring its accuracy and integrity.
Verifies patient insurance coverage with third-party payers.
Assures proper financial classification, determines proper guarantor, and updates system accordingly.
Contacts insurance companies, managed care plans and outside agencies to verify insurance coverage and benefits.
Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net and Qualified Health Plans (QHP), assisting in the application process when appropriate. Submits applications all Massachusetts applicants for health coverage via the Health Connector online using the Assistor Portal, paper by fax or by phone when required.
Maintains ongoing communication with government agencies regarding the status of claims, following up with patients as necessary to obtain required documentation to ensure that the state gets the info needed to process the applications in a timely matter.
Keep track of all cases using EPIC, Financial Assistance Module (FAM) along with a paper tickle filing system in addition to a daily productivity log sheet when necessary. Will also assist with out of state applications when appropriate.
Achieve and maintain mandatory ongoing department training and certification designation as Certified Application Counselor (CAC).
Provides updates and acts as a resource to hospital personnel including Patient Access, physicians, case management, and billing on financial matters as needed.
Acts as a Department resource, which may include assisting in the training of new hires, or the retraining of existing hires.
Acts as patient representative by assisting the patient in deciphering notices received from EOHHS. Assists patients in the redetermination process for MassHealth, Connector Care and or Health Safety Net, Health Connector, QHP or private health insurance.
Submit Social Security Protective Filing Form for NICU patients needing Social Security assistance.
Acts as a liaison between the patients, hospital billing department and BWPO practices/billing agencies in addressing any billing related inquires and issues and re-bill accounts when necessary for the Hospital and BWPO.
Create and provide estimates to patient, practice, or insurance company. Accepts and/or arranges payment for deductibles and outstanding balances utilizing Chapter 224 Patient Estimations Policy and Procedure. Counsels and advises patients of discount options available according to Partners guidelines.
Works to resolve collection disputes, collect payments from patients and post payments in EPIC Accounts Receivable System, Trust E-Commerce, CashPro, Work Center and secures cash drawer according to departmental procedures.
Utilizes knowledge of various payer requirements and when necessary, research any billing inquiries initiated by the patient, providing a comprehensive and comprehendible explanation to the patient, care coordination, physician and or practice staff.
Investigates MCO an ACO issues. Review visit notes/codes against what was entered in EPIC with RTE or another verification system to determine if an incorrect code was entered. Communicates with practice, physician, and billing to resolve problems regarding coding/billing issues.
Maintains a daily patient quota using EPIC and Financial Assistance Module (FAM) work queues.
Works on special projects, cover other services/alpha splits/work queues and/or locations, as well as other tasks when necessary.
Maintains Compliance with HIPAA and department regulations regarding patient confidentiality and privacy by accessing patient information only to the extent necessary to fulfill assigned duties. All patient information must be kept private, confidential, and secure. All lists, reports, files, and documents must always be properly secured and stored. Interviews and examinations should be conducted in such a manner as to afford the patient reasonable audio and visual privacy.
Maintains effective working relationships and communicates regularly with coworkers, care coordination, physicians as well as other departments to update and exchange pertinent account information.
Adheres to Customer Service Standards by demonstrating professionalism, alertness, helpfulness, and receptiveness to all patients, visitors, and other staff members.
Qualifications
What we need from you:
Bachelor's degree or equivalent preferred; high school diploma required.
3-5 years of experience in a hospital/health center setting, experience with prior authorizations, billing, and reimbursement helpful.
Must be willing to become a Certified Application Counselor (CAC).
Become a public benefits subject matter expert and remain up to date with the latest changes under the Affordable Care Act (ACA) and within the Massachusetts Medicaid system.
Understanding of government/state health insurance, including eligibility factors preferred
Demonstrated experience in credit, collection, and billing, preferably in a hospital/health center setting.
Knowledge of complex third party and medical assistance policies and procedures.
Ability to interpret billing manuals, insurance and/or other third-party coverage.
Must be able to understand the third-party review process and authorization procedures to ensure payment.
Basic keyboard skills and computer knowledge; good communication skills; good telephone skills, including use of multi-line phone.
Must have excellent organization and prioritization skills, possess strong verbal and written communication skills, and thrive in a demanding atmosphere.
Must obtain the ability to prioritize workload and possess ability to meet tight time frames and follow through skills.
Must obtain the ability to work under minimal supervision, is detail oriented and possess problem-solving skills.
Knowledge of medical terminology helpful
Experience working with Microsoft Office and Share Point preferred.
Bilingual preferred.
Interactions/Interpersonal Skills:
Able to critically analyze problems and use lateral thinking to provide effective solutions.
Excellent attention to detail and the ability to juggle multiple responsibilities and competing priorities.
Adeptness at making decisions under pressure and meeting tight deadlines in a fast-paced environment.
Able to provide superb customer service while building and maintaining positive working relationships.
Must have a positive attitude towards working independently and within a team environment and always take the initiative to help others.
Maintain excellent written and oral communication skills and communicate effectively in a sensitive and timely manner.
Interpersonal relationship skills necessary to communicate effectively with co-workers, patient/family, physicians, care coordination, billing, other hospital personnel, in addition to and many external organizations and agencies.
Ability to function independently and prioritize work within established policies.
Requires good judgment, tact, sensitivity, and the ability to function in a stressful environment.
Ability to maintain confidentiality regarding the patients, their medical histories, demographic and fiscal information, etc.
Professional demeanor and attitude and the ability to work effectively with others.
EEO Statement
BWH is an Affirmative Action Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
