Financial Counselor-Full Time-Days

Cape Fear Valley Health; Fayetteville (NC); On-site; USD 36,000 - 48,000; Full time

Job summary

Cape Fear Valley Health in Fayetteville, NC seeks a Patient Access Specialist to support the PFS Financial Clearance area. This clerical role handles preadmission activities, verifies insurance, and collects patient responsibilities at the point of service.

You will interview patients, obtain demographics and financial details, determine required authorizations, and document information in the registration system while complying with HIPAA and hospital policies.

Qualifications

• English reading/writing and communication skills are required.
• Knowledge of insurance and collection of payments is needed.
• Knowledge of Medical Terminology is required.
• Familiarity with Microsoft Office software is expected.
• Strong customer service and problem-solving abilities are essential.
• Ability to manage stress and adapt to patient needs and schedules.
• Employees may rotate shifts and hours to meet department needs.

Responsibilities

• Contacts and interviews patients, responsible parties and insurers regarding hospital services to secure benefits.
• Performs insurance eligibility/benefit verification and documents in the registration system.
• Determines need for pre-certifications and authorizations and contacts payers/physicians as needed.
• Pre-registers patients with demographic, financial, and insurance information.
• Validates medical necessity and ensures authorization matches tests/procedures.
• Contacts physicians for clarification when needed.
• Informs patients of liabilities and collects co-pays and balances at registration.
• Calculates patient liabilities and provides financial counseling and payment arrangements.
• Screens patients for market insurance and follows up on denials; initiates appeals as needed.
• Maintains HIPAA-compliant patient information and assists with documentation.
• Meets accuracy standards and resolves missing documentation; performs other duties as assigned.

Skills

English language proficiency

Insurance knowledge

Medical terminology

Microsoft Office

Customer service

Problem solving

Communication skills

Stress management

Flexibility

Education

High school diploma or equivalent

Associates degree in Business or Health Care Administration

CPAS certification within 1 year

Tools

Microsoft Office

Job description

Work Shift

Rotating Shifts (United States of America)

Facility

Cape Fear Valley Medical Center

Location

Fayetteville, North Carolina

Department

PFS Financial Clearance

Job Family

Clerical

Summary

Receives accounts and/or schedules for review and work-up regarding preadmission, admission, or add-on procedures, and services. Interviews patients for necessary account follow-up, to obtain accurate and detailed demographic, and financial information. Verifies insurance information, benefits, and initiates medical certification; reviews medical necessity, and assures that authorization is noted on file with supporting reference for the appropriate procedure, service, and/or patient status. Receives, reviews, and completes necessary follow-up for encounter denials. Notifies patients of financial responsibility; explains and reviews insurance coverage, and collects patient’s responsibility via phone, or at time of service, to include initiation of payment arrangements if needed, or as required.

Major Job Functions

• Contacts and interviews patients, responsible parties and insurance companies regarding hospital or ambulatory service to secure insurance benefits.
• Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system, supporting with reference number.
• Determines the need for appropriate service authorizations (pre-certifications, 3rd party authorizations, referrals) and contacts the payer, physician and/or case management/utilization review personnel, as necessary. Ensure authorization matches test(s) ordered
• Pre-registers the patient for upcoming visit(s) including validating/obtaining and entering demographic, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).
• Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.
• Calculates patient liabilities and provides financial education, referring the patient to resource counseling, as required. Documents payments/actions in the patient accounting system and provides the patient with a payment receipt. Assists patient with payment arrangements as needed for remaining balance.
• Properly screens appropriate patients for market insurance.
• Obtains signed physician orders for scheduled tests and procedures from physicians/offices for testing and procedures, and scans into electronic record.
• Completes appropriate follow-up on insurance denials and initiates appeal, retro-authorization, etc. as needed.
• Assists insurance companies, physician, and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines.
• Meets or exceeds accuracy standard goal determined by Patient Access Leadership; Ensures integrity of patient accounts by working error reports daily, entering accurate data, and documenting all attempts made to collect and or obtain missing documentation.
• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education And Formal Training

• High school graduate or equivalent required
• Associates Degree in Business or Health Care Administration and/or Computer Technology preferred
• Patient Access Specialist certification (CPAS) required within 1 year of employment

Work Experience

• 1 year insurance/clerical experience within a hospital or medical office setting

Knowledge, Skills, And Abilities Required

• Proficiency in reading, writing, and speaking the English language
• Knowledge of insurance and collection of payments
• Knowledge of Medical Terminology
• Knowledge of Microsoft software
• Excellent verbal and written communication skills, customer service skills and problem-solving abilities
• Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
• May be required to periodically rotate shifts and regular days off
• All system employees must have the flexibility to meet the department hours of operation

Physical Requirements

• Must be able to communicate orally, see, and hear to collect information
• Must have dexterity to operate office equipment.
• Position operates in an office, call center environment
• The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen.
• The noise level is low to moderate.
• Bends, reaches, pushes and pulls file drawers to file records and reports.
• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.

Required Licenses And Certifications

CPAS - Healthcare Business Insights

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity