Financial Counselor

Lexington Medical Center; West Columbia (SC); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Day ONE medical, dental and life保险

FSAs

403(b) match plan day one

Employer paid life insurance

Adoption assistance

Short-term & long-term disability

Student loan forgiveness

Job summary

Lexington Health, Inc. seeks a Billing Specialist to counsel patients on insurance benefits and establish payment arrangements in line with policy. The role focuses on collecting payments, applying regulations, and maintaining billing integrity to support the practice’s financial health.

You will interpret EOBs, follow payer guidelines, and collaborate with CBO staff to address denials and ensure timely reimbursements. Strong knowledge of ICD-10, CPT, HCFA 1500 and Medicaid/Medicare is required.

Qualifications

• High School Diploma or equivalent.
• 6 months of insurance experience in a healthcare setting.
• Procedural knowledge of billing across commercial, Medicaid, Medicare, Workers' Compensation and other payers.
• Extensive knowledge of medical terminology, HCFA 1500, ICD-10, and CPT coding.

Responsibilities

• Post patient payments and assist with posting insurance payments.
• Research and follow-up on denials, corrections and rejections.
• Interpret EOBs, bulletins, and payor guidelines to ensure accurate billing.
• Provide education to staff regarding financial counseling and payer communication.
• Assist patients and staff with claims, payments, and pre-certifications.
• Maintain billing integrity and ensure compliance with contractual requirements.

Skills

Insurance billing

Medical terminology

Customer service

Billing compliance

Communication skills

Education

High School Diploma or Equivalent

Tools

HCFA 1500

ICD-10 coding

CPT coding

Job description

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Lexington Oncology
Full Time
Day Shift
8:00am-4:30pm Mon-Fri

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bedteachinghospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcareand was first in the state to achieve Magnet with Distinction status for excellence in nursing care. Consistently ranked as bestin the Columbia Metroarea by U.S. News & World Report, Lexington Healthdelivers more than 4,000babies each year, performs more than 34,000surgeries annually and isthe region's third largest employer.

Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first HeartCARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center.Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

Job Summary

Responsible for counseling patients regarding their insurance benefits; with accountability for collecting and/or establishing financial payment arrangements to adhere to LMC policy regarding the financial responsibility according to insurance carrier and/or self-pay obligations in order to have a positive financial impact on the practice. Interprets and applies compliance guidelines to maintain billing integrity.

Minimum Qualifications

Minimum Education: High School Diploma or Equivalent
Minimum Years of Experience: 6 months insurance experience in a healthcare setting
Substitutable Education & Experience: None.
Required Certifications/Licensure: None.
Required Training: Procedural knowledge of commercial, Medicaid, Medicare, Workers' Compensation, all contractual third party payers, other private carriers, billing, reimbursement, and regulatory compliance; Extensive knowledge of medical terminology, HCFA 1500, ICD10, and CPT coding.

Essential Functions

• Works independently but closely with manager and operations director or division administrator.
• Assist patient with benefit coordination to assure the appropriate financial obligation and responsibility is met in a timely manner.
• Identify potential billing issues and act to resolve those problems quickly, and work collaboratively with physicians and managers regarding effectiveness in reimbursement rates, billing and collection.
• Expectation is to stay current on all Governmental Reimbursement programs in order to provide assistance and guidance to leadership on reimbursement-related matters within the LMC contractual agreements.
• Accurately prepare financial payment statements outlining benefits and collect appropriate funds and/or establish payment arrangements prior to date of surgery to maintain A/R days within set goals, as required.
• Obtain and verify appropriate documentation from payor to establish coordination for clean claims.
• Communicates with the CBO to assist as appropriate in the writing of appeals for denied claims and follow up on claims processing.
• Assist CBO staff with accounts and reviews invoices for accuracy and completeness as deemed appropriate.
• As requested, calculate estimates for visits, procedures, and/or surgeries, electronically managing records of estimates provided.
• Verifies accuracy and correct use of ICD10 and CPT coding.
• Compliance with carrier’s policies.

Duties & Responsibilities

• Post patient payments and assist with posting insurance payments, as deemed appropriate.
• Research and follow-up on denials, claim corrections and rejections, as requested.
• Provides accurate interpretation of EOBs, bulletins, advisories, fee schedules, payor guidelines, regulations and all other pertinent information.
• Provides education to all office staff regarding financial counseling.
• Assists patient, office staff, and insurance companies regarding claims, payments, adjustments, referrals and pre-certifications.
• Maintains all informational material received from insurance companies, documenting all information within account notes.
• Responsible for maintaining billing integrity: Fraudulent or abusive billing practices, (i.e., duplicate billing, overstating charges, etc.). Any exceptions should be brought to the immediate attention of the manager.
• Demonstrates knowledge of commercial, Medicaid, Medicare, Workers’ Compensation, all contractual third party payors and other private carriers.
• Prepares and runs reports on a daily, weekly, monthly basis or as deemed appropriate.
• Helps maintain the work area in a neat and orderly fashion. Responsible for keeping supplies needed to perform the job duties.
• Demonstrates appropriate communication of information to all ages and responds to all customers/ patients requests and needs, i.e., hard of hearing, etc.
• Respond to customer inquiries, complaints and correspondence in a prompt and professional manner to conform to LMC’s Service Excellence guidelines and LMC’s corporate compliance.
• Performs all other duties as assigned.

We are committed to offering quality, cost-effective benefits choices for our benefit eligible employees and their families:

• Day ONE medical, dental and life insurance benefits
• Health care and dependent care flexible spending accounts (FSAs)
• Employees are eligible for enrollment into the 403(b) match plan day one. LHI matches dollar for dollar up to 6%.
• Employer paid life insurance – equal to 1x salary
• Employee may elect supplemental life insurance with low cost premiums up to 3x salary
• Adoption assistance
• LHI provides its full-time employees employer paid short-term disability and long-term disability coverage after 90 days of eligible employment
• Student loan forgiveness

Equal Opportunity Employer
It is the policy of Lexington Health to provide equal opportunity of employment for all individuals, and to remain compliant with applicable state and federal laws and regulations. Lexington Health strives to provide a discrimination-free environment, and to recruit, select, on-board, and employ all employees without regard to race, color, religion, sex, age, disability, national origin, veteran status, or pregnancy, childbirth, or related medical conditions, including but not limited to, lactation. Lexington Health endeavors to upgrade and promote employees from within the hospital where possible and consistent with the employee’s desires and abilities and the hospital’s needs.