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Job Summary
The Financial Counselor's essential duties consist of conducting comprehensive patient interviews while adhering to the Financial Assistance Program standards. Verifies the potential of third party coverage, determine if patients meet criteria for third party assistance programs and completes applications as appropriate. Complies with third party payer standards related to obtaining authorizations/ precertifications. Accurately enters patient information into the enterprise hospital information system, i.e., Epic. Complies with regulatory compliance standards by explaining various documents and obtaining signatures.
RESPONSIBILITIES :
35% - Interacts with patients, family members, employees, visitors and clinicians regarding financial clearance.
Provides assistance to patients via the call center, online, and in-person regarding third party payer and eligibility requests.
Conducts accurate interviews with patients or patients’ representatives to determine eligibility for assistance. During the interviewing process, determine if patients meet criteria for any assistance programs and/or Grady’s Financial Assistance Program.
Verifies third party payer information or the possibility of third party payer coverage via electronic verification tools or telephone. Notifies payer of patient’s hospital admission. Obtains prior authorization for scheduled procedures, Ambulatory Surgeries and Surgery Admits. Accurately performs registrations and Epic updates with patient demographic, insurance information and authorization accurately.
Communicates effectively and provides written documentation to patients regarding discounts and patient financial responsibility.
Analyzes and resolves patient billing inquiries and make adjustments to ensure proper collections of the patient’s financial responsibility related to eligibility for financial assistance
20% - Determine if patient meets criteria for other assistance programs and complete applications for assistance as appropriate.
Completes program applications, e.g., Medicaid, Cancer State Aid, Georgia Crime Victims Compensation Program, etc., application(s) for eligible patients. Secures newborns Medicaid Recipient’s Numbers via GAMMIS.
Submits applications to the appropriate organization for review, approval and/or denial in a timely manner.
Updates Epic accurately and timely with converted applications and/or status notes.
40% - Ensures financial clearance by verifying third party payer information, coordinating benefits, initiating third party payer notification for emergency admissions/observations, and/or obtain third party payer authorizations.
Conducts bedside interviews and pre-admission/ambulatory surgery patient interviews to ensure all regulatory compliance documents are explained and patient/patient representative signature is obtained.
Verifies third party payer information and/or the possibility of third party coverage. Updates Epic with insurance information and coordinate benefits when appropriate.
Initiates third party payer notification for emergency admissions/observations within payer’s specified timeframe and updates Epic with status and notes.
Coordinates financial clearance for pre-admissions by securing authorization, scheduling pre admission appointments, if applicable, and collecting co-payments/deposits prior to service and post discharge.
Escorts patients and/or patients’ families to various service areas for elective services.
5% - Other duties as assigned.
Must possess knowledge of Hospital Information/Enterprise systems, i.e., EPIC.
QUALIFICATIONS:
2 + Years - Job related experience in: financial counseling, patient access, billing, cash collections, insurance verification, authorization / pre-certification or…