Financial Counselor-Full Time-Days

Cape-Fear-Valley-Medical-Center-; Raeford (NC); On-site; USD 32,000 - 42,000; Full time

Job summary

Cape Fear Valley Health System is seeking a Patient Access Specialist at Hoke Hospital in Raeford, NC. The role involves verifying insurance, pre-registering patients, and explaining financial responsibilities to ensure smooth admissions.

The position requires strong communication, clerical accuracy, and knowledge of billing processes. Hospital/medical office experience and CPAS timeline are valued, with opportunities for growth within the PFS Financial Clearance department.

Qualifications

• High school graduate or equivalent; Associate degree preferred.
• CPAS certification required within 1 year of employment.
• 1 year of insurance/clerical experience in a hospital or medical office.
• Proficient in English; strong communication and customer service.
• Knowledge of insurance, collections, medical terminology, and MS Office.

Responsibilities

• Verify insurance eligibility/benefits with payers and document in the registration system.
• Pre-register patients with demographic, financial, and insurance data.
• Explain patient financial responsibilities and collect co-pays/deductibles.
• Obtain required authorizations/referrals and coordinate with care teams.
• Document payments and actions in patient accounting; follow up on denials and appeals.
• Interact with patients, payers, and providers to resolve issues and ensure accurate records.

Skills

Verbal communication

Written communication

Customer service

Problem solving

Insurance knowledge

Billing/collections

Medical terminology

Microsoft Office

Clerical experience

CPAS certification

Education

Associate degree preferred

CPAS certification within 1 year

High school diploma or equivalent

Tools

Microsoft Office

Job description

FacilityHoke HospitalLocationRaeford, North CarolinaDepartmentPFS Financial ClearanceJob FamilyClericalWork ShiftDays (United States of America)SummaryReceives 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 FunctionsThe following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time: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) orderedPre-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 assignedMinimum QualificationsThe 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 requiredAssociates Degree in Business or Health Care Administration and/or Computer Technology preferredPatient Access Specialist certification (CPAS) required within 1 year of employmentWork Experience:1 year insurance/clerical experience within a hospital or medical office settingKnowledge, Skills, and Abilities Required:Proficiency in reading, writing, and speaking the English languageKnowledge of insurance and collection of paymentsKnowledge of Medical TerminologyKnowledge of Microsoft softwareExcellent verbal and written communication skills, customer service skills and problem-solving abilitiesAbility 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 offAll system employees must have the flexibility to meet the department hours of operationPhysical Requirements:Must be able to communicate orally, see, and hear to collect informationMust have dexterity to operate office equipment.Position operates in an office, call center environmentThe 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 CertificationsCPAS - Healthcare Business InsightsCape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity