Financial Counselor-MSHAR

UMass Memorial Health; Marlborough (MA); On-site; USD 39,000 - 62,000; Full time

Benefits offered by this job

Signing bonus potential

Union: SHARE Marlborough

Job summary

UMass Memorial Health is seeking a Financial Counselor (CAC required) to assess patients' health coverage options, determine eligibility for MassHealth, Health Connector, and related programs, and guide families through the enrollment process.

Reporting to Financial Counseling leadership, you will staff the call center, coordinate with clinics, and ensure accurate documentation, while upholding the organization's standards of respect and patient-centered care.

Qualifications

• High School Graduate; CAC certification required within 45 days of hire.
• CAC certification within 45 days of hire is required.
• Preferred: Associate or bachelor’s degree in Business, Social Services or related field.

Responsibilities

• Interviews and screens applicants to determine eligibility for health coverage.
• Determines qualification for affordable health insurance coverage, including premium tax credits and other programs.
• Interacts with patients and external partners professionally per UMMHC mission.
• Facilitates enrollment through Health Connector or other programs with accurate paperwork.
• Follows up with patients to obtain necessary confidential information for eligibility.
• Acts as liaison for MassHealth and Health Connector to resolve eligibility issues.
• Explains eligibility rules, coverage types, enrollment periods, and plan options.
• Manages the financial counseling call center as a resource for patients and staff.
• Provides price estimates to patients per price transparency regulations.
• Works with EPIC work queues to identify uninsured/underinsured patients for assistance programs.
• Collaborates with clinical areas and community partners to ensure access to care.
• Discusses financial obligations before elective procedures and communicates with providers.
• Updates accounts to reflect current status and eligibility dates.

Skills

Customer service

Data entry

Effective communication

Healthcare billing

English proficiency

Education

High School Graduate

CAC certification (within 45 days)

Associate or Bachelor’s degree (preferred)

Tools

EPIC software

Job description

Are you a current UMass Memorial Health caregiver?

Exemption Status: Non-Exempt

Hiring Range: $18.76 - $29.96

(based on a full time schedule of 40 hours per week).

Please note that the final offer will vary based on scheduled hours. Compensation for part-time or reduced schedules will be prorated based on scheduled weekly hours, experience, skills, qualifications, and internal equity considerations.

Schedule Details: Monday through Friday

Scheduled Hours: 8am - 4:30pm

Shift: 1 - Day Shift, 8 Hours (United States of America)

Hours: 40

Cost Center: 10021 - 5640 Patient Accounting

Union: SHARE Marlborough

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

Under the general direction of the Financial Counseling Supervisor/Manager and/or Financial Clearance Director, the Financial Counselor (Certified Application Counselor) provides a key role in providing a health care coverage needs assessment with patients, community applicants, and family members. Determines eligibility for MassHealth, Qualified Health Plans, Children's Health Insurance, Health Safety net and any other coverage that they may qualify. Provides guidance and assistance to patients, various internal UMass staff, physician offices and third-party vendors regarding financial assistance programs.

II. Major Responsibilities:

• 1. Interviews, screens and assess applicants and family members in a variety of on campus locations utilizing income and household composition and other criteria in accordance with CMS and other governmental established guidelines for program eligibility.
• 2. Determines qualification for affordable health insurance coverage, including the application of advance premium tax credits (APTC), premium assistance programs, Medicare Savings Plans and any other program they may be determined eligible.
• 3. Interacts with patients, the community, and outside agencies in a professional manner in keeping with the Mission and Vision of UMMHC.
• 4. Facilitates enrollment through the online Health Connector Health Insurance Exchange (HIX) or any other program application by accurate and timely submission of necessary paperwork according to state and federal regulations and policies.
• 5. Follows up with patients in person or by telephone to obtains appropriate confidential financial and medical information on incomplete applications.to establish eligibility for various financial assistance programs.
• 6. Acts as the liaison for patients with MassHealth, the Health Connector and the Health Safety Net to assist in the resolution of eligibility discrepancies, applications status updates, and any other issue that may arise in the determination process.
• 7. Facilitates patient understanding of health access options including but not limited to eligibility rules, coverage types, enrollment periods, products and plans available through MassHealth, the Health Connector, Medicaid Managed Care, and the Health Safety Net program.
• 8. Responsible for coverage of the Financial Counseling call center to act as a resource for patients and families, members of the community, clinical departments and other Revenue Cycle departments with insurance coverage issues and questions.
• 9. Provides and documents price estimates request to patients in accordance with federal price transparency regulations.
• 10. Works within EPIC work queues to identify and reach out to uninsured/underinsured patients/families (inpatient, outpatient, surgical day, psychiatric in patients, psychiatric outpatients, etc.) for the purpose of screening for assistance programs and upgrades to a richer benefit program.
• 11. Works in conjunction with clinical areas, interpreters, social workers, case managers, social security outreach workers, drug assistance coordinator, enhanced benefit coordinator, care mobile, physician/provider offices and community health centers as needed to ensure access to care and timely discharge planning.
• 12. Discusses financial obligations with patients prior to elective surgical days or admissions. Communicates all information to provider offices and other Revenue Cycle departments.
• 13. Updates all accounts to reflect the current account status with appropriate financial class, eligibility dates, other patient financial and demographic information.

Standard Staffing Level Responsibilities:

• 1. Complies with established departmental policies, procedures and objectives.
• 2. Attends variety of meetings, conferences, seminars as required or directed.
• 3. Demonstrates use of Quality Improvement in daily operations.
• 4. Complies with all health and safety regulations and requirements.
• 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• 6. Maintains, regular, reliable, and predictable attendance.
• 7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

III. Position Qualifications:

License/Certification/Education:

Required:

• High School Graduate.
• Certified Application Counselor (CAC) certification required within 45 days of hire as a condition of employment.
• Completes annual recertification and all mandatory ongoing training provided by the Massachusetts on-line Learning Management System and complies with privacy and security regulations that meet all federal program standards.

Preferred:

• Associate or bachelor's degree in Business, Social Services or related field.

Experience/Skills:

Required:

• Previous experience in healthcare, accounts receivable, Financial Counseling, medical billing, or a related field.
• Proficient data-entry and strong organization skills with attention to detail.
• Effective communication and customer service skills both verbal and written.
• Ability to use specialized applications software and computers systems for patient registration and scheduling.
• Ability to work independently with strong problem resolution skills.
• Must provide own transportation.
• Ability to prioritize and work in high volume, fast paced, team-oriented environment.
• Ability to take directions and work independently.
• English speaking, reading and writing skills

Preferred:

• Bilingual speaking, reading.

Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

Department-specific competencies and their measurements will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

IV. Physical Demands and Environmental Conditions:

Work is considered light with frequent walking throughout the day. Position requires work indoors in a normal office and/or patient care environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at [e-mail]. We will make every effort to respond to your request for disability assistance as soon as possible.