Financial Counselor - Decatur (U) (4583)

SIU Medicine; Decatur (IL); On-site; USD 42,000 - 52,000; Full time

Job summary

SIU Medicine seeks a Financial Counselor to work on-site at our Decatur FQHC, helping patients obtain medical coverage and enroll in Medicaid or Marketplace plans. The role requires documenting patient information, maintaining certifications, and coordinating with providers and insurers to resolve coverage issues.

The position focuses on eligibility, assistance forms, and patient outreach to explain options and ensure accurate billing and enrollment. On-site presence is required.

Qualifications

• Two years or more in health insurance enrollment, eligibility, or related field.
• Experience with Medicaid, Marketplace plans, or open enrollment preferred.
• Knowledge of eligibility rules for FQHC or similar clinics.
• Familiarity with EHR/Practice Management systems and HIPAA rules.
• Ability to communicate complex coverage options to patients clearly.

Responsibilities

• Assist patients with seeking coverage and enrollment for Medicaid or Marketplace plans.
• Act as on-site liaison for the 340b program and coordinate with providers and insurers.
• Maintain certification requirements for Assisters at state and federal levels.
• Prepare reports showing applications reviewed, approved, and poverty level qualifications.
• Enter and update patient financial statements and assistance applications in the EHR.
• Provide outreach and education on Open Enrollment and insurance concepts.

Skills

Customer service

English language

Medical terminology

Numeracy

HIPAA compliance

Computer skills

Attention to detail

Training others

Team collaboration

Supervising/leadership

Education

Health-related coursework

Business/HR management

Associate's Degree

Tools

IDX

TouchWorks EMR

Abe.Illinois.gov

Healthcare.gov

MEDI System

Medicare Plan Finder

Job description

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Description

This position works on site at the Federally Qualified Health Center (FQHC) and serves as a financial counselor to patients. The position is responsible for assisting patients in obtaining medical coverage and for qualifying and enrolling patients for coverage through the Affordable Care Act either with Medicaid or through the State of Illinois Insurance Exchange. This position will also analyze patient information to insure correct documentation.
*This position is ON SITE only*

Examples of Duties

Patient Coverage/Eligibility 50%
1. Enforce and implement FQHC federal rules and regulations regarding eligibility for patients with no insurance to qualify for Medicaid, Medicare, insurance through the Marketplace, or other available options.
2. Serve as the on-site primary contact for the 340b program.
3. Assists patients in finding affordable options to fill prescriptions for both emergent and maintenance medications.
4. Maintains required certifications for Assisters at both state and federal levels.
5. Tracks and monitors all incoming patient assistance forms; reviews for completion, ensures patient is notified appropriately and that forms are scanned appropriately into patient's record.
6. Assists patients in completing applications, reviews patient applications and financial statements and informs patients of required personal financial statements and documents.
7. Documents notes and adjustments in the practice management system to keep patient's account accurate and up to date and to inform others who may access the account.
8. Documents notes in the EHR, as appropriate, and in the FQHC financial tracking sheet in a timely manner.
9. Assist patient by providing the appropriate information for them to apply for coverage through the appropriate plan or assist them to apply on-site.
10. Keep detailed records to include patient's application for assistance and patient's financial statements.
11. Serves as a liaison between providers, pharmacies and insurance agencies in order to facilitate the resolution of escalated, complex healthcare navigation.
12. Prepare weekly report for Administrator to include numbers of applications reviewed, numbers approved, and number of patients who qualify for plans by percentage of poverty level.
13. Keep abreast of other coverage options for patients, ie, Illinois Breast and Cervical Cancer Program (IBCCP), Planned Parenthood, Local County Health Department, and others.
14. Respond to a variety of questions from physicians, hospitals, government agencies, insurance companies and related interested parties concerning the status of insurance benefits.
15. Attend workshops and seminars conducted by the Illinois Primary Health Care Association and the State of Illinois to stay informed

Financial Counseling/Collections 30%
1. Handle patient requests on-site or by telephone regarding billing process and inquires and make appropriate entry of actions taken in the practice management system.
2. To perform duties, master the use of the following internal and external systems:
Internal: IDX, TouchWorks EMR
A. Abe.Illinois.gov
B. Healthcare.gov
C. State of Illinois MEDI System
D. Medicare Plan Finder
3. Attend relevant webinars or trainings to relay information and to provide updates.
4. Keep abreast of online updates from HFS, CMS and forward important information to appropriate units affected, eg, new approved drug lists, changes in payments for certain services, etc.
5. Use guidance from CMS and other national partners to identify vulnerable populations and develop outreach strategies.
6. Leveraging network of community partners and relevant social media tools, conduct outreach to educate the public about Open Enrollment, health insurance concepts, the FQHC program, and the healthcare system at large.
7. Perform eligibility checking using MEDI as needed.
8. Other duties as assigned by Health Care Administrator.

Referrals and Prior Authorizations 20%
1. Assists in completing patient referrals and external preauthorizations:
a) Assists patients with securing referrals to specialist physicians, health care agencies, and hospitals.
b) Works with managed care organizations and the physician's office, providing appropriate documentation for referrals, authorizations for hospital, testing or other services.
c) Responsible for determining and disseminating the required information from the patient's medical records, i.e., chart notes, school physicals, laboratory results, x-rays, etc., to assure the medical necessity of the request to the consultant, and/or insurance/managed care company
d) Helps to maintain up-to-date directory of services provided to SIU Center for Family Medicine Decatur patients by specialists and health care agencies
e) Contacts managed care companies concerning status of referrals and preauthorizations.
f) Keeps faculty physicians, resident physicians, nurse practitioners, physician assistants, nurses and other staff at the clinic informed about the requirements and medical necessity guidelines of managed care referrals and authorization requests.
g) Provides feedback regarding the development of appropriate forms for internal and external use as it relates to referrals and preauthorizations.
h) Maintains the ability to appropriately handle referrals, schedule appointments, answer general patient questions; knowledgeable about procedures and services
i) Maintains up-to-date on Medicare, Medicaid and Managed Care Guidelines.
j) Helps to monitor referral reports, and assists with timely follow-up in accordance with policy and procedure.
k) Enters referral and preauthorization information into the electronic medical records and computer system according to policy and procedure.
I) Maintains operating knowledge of the following systems IDX, TouchWorks, MEDI, EPIC and dbMotion.

Qualifications

Credentials to be Verified by Placement Officer

1. Any one or combination totaling two (2) years (24 months), from the categories below:
   1. College coursework in a health-related field, business administration/management, human resource management, or closely related fields, as measured by the following conversion table or its proportional equivalent:
      • 30 semester hours equals one (1) year (12 months)
      • Associate's Degree (60 semester hours) equals eighteen months (18 months)
      • 90 semester hours equals two (2) years (24 months)
   2. Work experience in a healthcare environment working independently with medical claims, denials, rejections, referrals, and prior authorizations.

Knowledge, Skills & Abilities (KSAs)

1. Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction.
2. Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
3. Knowledge of complex medical terminology, hospital or physician billing and coding, referrals, and prior authorizations.
4. Knowledge of arithmetic with the ability to add, subtract, multiply and divide whole numbers, decimals and percentages.
5. Skill in evaluating information to determine compliance with standards. Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, standards and ensuring that lower-level employees are following standards.
6. Skill in using computers and computer systems (including hardware and software) to program, write, set up functions, enter data, or process information.
7. Ability to pay close attention to details, follow established procedures to complete work tasks and train others in those procedures.
8. Ability to maintain patient confidentiality following HIPAA guidelines and established policies and procedures.
9. Ability to train others and work collaboratively, building strategic relations with colleagues, coworkers, constituents.
10. Ability to plan, assign, and supervise the work of others.

Condition of Employment

Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.

Supplemental Information

If you require assistance, please contact the Office of Human Resources at [e-mail] or call 217-545-0223 Monday through Friday, 8:00am-4:30pm.

The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

Southern Illinois University School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the
"Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."

Southern Illinois University School of Medicine is an affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

Pre-employment background screenings required.